Maintaining Oxygenation Successfully with High Flow Nasal Cannula during Diagnostic Bronchoscopy on a Postoperative Lung Transplant Patient in the Intensive Care.

Sara Diab,John F Fraser

doi:10.1155/2014/198262

Abstract

Bronchoscopy is an important diagnostic and therapeutic intervention for a variety of patients displaying pulmonary pathology. The heterogeneity of the patients undergoing bronchoscopy affords a challenge for providing minimal and safe respiratory support during anesthesia. Currently, options are intubation and general anesthesia versus frequently inadequate sedation or local anaesthesia with low flow oxygen through nasal prongs or mouthpiece. The advent of high flow nasal cannula allows the clinician to have a “middle man” that allows high flow oxygen delivery as well as a degree of respiratory support, which in some cases has been noted to be between 3 and 4 cm of continuous positive airway pressure-like effect. There are minimal data analyzing the use of high flow nasal cannula during anesthesia for bronchoscopy. We present a case report of orthotropic lung transplant recipient undergoing diagnostic bronchoscopy whilst being supported with high flow nasal oxygen in the intensive care unit.

Highlights

Bronchoscopy is an invasive procedure, which occurs in patients with some degree of pulmonary pathology, performed for diagnostic and therapeutic intervention
Induction of general anesthesia for bronchoscopy is associated with certain risks including hypoxemia, increased work of breathing, collapse of upper airways, and reduction in end-expiratory lung volumes
This case report demonstrates the successful maintenance of oxygenation on a postoperative lung transplant subject receiving diagnostic bronchoscopy using the novel method of respiratory support, High flow nasal cannula (HFNC), in the intensive care unit

Summary

Introduction

Bronchoscopy is an invasive procedure, which occurs in patients with some degree of pulmonary pathology, performed for diagnostic and therapeutic intervention. High flow nasal cannula (HFNC) oxygenation is an emerging therapy for respiratory support that delivers heated and humidified air and oxygen with flows of up to 60 L/min. Diverse capability for effective therapeutic use of HFNC is growing in the literature, with the presence of potentially beneficial pharyngeal positive pressure repeatedly reported [2,3,4,5]. This case report demonstrates the successful maintenance of oxygenation on a postoperative lung transplant subject receiving diagnostic bronchoscopy using the novel method of respiratory support, HFNC, in the intensive care unit

Case Report

Discussion