High-Flow Nasal Cannula Oxygen Delivery during Bronchoalveolar Lavage: A Question of Methodology Influence?

Article information

Tuberc Respir Dis. 2019;82(1):86-87

Publication date (electronic) : 2018 December 19

doi : https://doi.org/10.4046/trd.2018.0058

Subrata Kumar Singha, M.D., P.D.C.C.¹, Antonio M Esquinas²

¹Department of Anaesthesia & Critical Care, All India Institute of Medical Sciences, Raipur, India

²Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain.

Address for correspondence: Subrata Kumar Singha, M.D., P.D.C.C. Department of Anaesthesia & Critical Care, All India Institute of Medical Sciences, Tatibandh, Raipur 492099, CG, India. Phone: 91-8518881767, subratsingh@gmail.com

Received 2018 July 10; Revised 2018 August 10; Accepted 2018 September 06.

Desaturation during bronchoalveolar lavage (BAL) is a critical condition that could delay the procedure and recommendations about the appropriate complementary oxygenation technique are controversial. Recently, high flow nasal cannula (HFNC) is an appropriate alternative to avoid these complications; however, there is scarce information about the real clinical impact12. In this line we have read with great interest the study by Kim et al.3 which described the use of HFNC in patients undergoing BAL. After careful analysis we consider that there are some key aspects that have to be taken into consideration for a proper clinical extrapolation such as firstly, the authors, have used variable flow (L/min) in the study, which could interfere with the real evaluation of hypoxemic conditions and there is no clear explanation about the same. Secondly, although the authors did not describe significant variations in oxygen saturation levels before, during, and after BAL measured by pulse oximeter (saturation of partial pressure oxygen) values as 94.8±2.9%, 94.6±3.5%, and 95.2±2.8%, respectively, it did not exclude the underlying clinical hypoxemic conditions as they may have been maintained by increasing the fraction of the inspired air concentration values. Thirdly, the authors included only the first 24-hour observation period but we are of the opinion that it would be intriguing to extend the observation period for a longer period to properly evaluate late complication if any4, which the other clinical studies have described. Last but not the least, we also opine that the protocol for sedation would also influence the desaturation rate as mentioned in a study by Douglas et al.5.

We have to exclude positive end expiratory pressure effect during BAL since it would be difficult to interpret the same during bronchoscopy.