Abstract Rationale High-flow nasal cannula (HFNC) is a well-established method of delivering heated, humidified oxygen at high flow rates while providing variable positive airway pressure. While the benefits of HFNC in patients with acute hypoxemic respiratory failure are well established, randomized controlled trials examining HFNC use in patients during bronchoscopy have been smaller and with more uncertain results. Since its introduction at Hamilton Health Sciences (HHS), McMaster University in 2023, HFNC has been selectively used to facilitate bronchoscopy in high-risk patients at the discretion of individual proceduralists. We aim to describe the characteristics of patients receiving HFNC during bronchoscopy at HHS over the past two years and their outcomes. Methods We conducted a retrospective chart review of all adult patients who underwent bronchoscopy with HFNC at HHS between July 1, 2023 and June 30, 2025. We collected demographic, clinical, and procedural data from the electronic medical records and defined intra-procedural complications as desaturation at any time (SpO2 90% or ≥ 10% decline from baseline) or early procedure termination. We also captured post-bronchoscopy adverse events including either immediate escalation of care (i.e. code blue activation, admission to ICU) or delayed (within 24 hours of procedure) complications (i.e. clinical deterioration needing higher level of care or respiratory compromise such as prolonged time to return to pre-procedure oxygen requirements). Results We included a total of 121 patients (92 inpatients, 29 outpatients) who underwent bronchoscopy and were administered HFNC during the procedure. Baseline patient demographics, clinical characteristic and procedural details are shown in Table 1. Overall, 53 patients (47%) had no intra-procedural complications or post-procedural adverse events, 15 patients (13%) experienced only intra-procedural complications, and 53 patients (47%) experienced either an immediate (5 patients) or delayed (48 patients) adverse clinical event after bronchoscopy. There were more complications (of any type) in inpatients as compared to outpatients (63% vs. 35%, p = 0.01). Conclusions In this high-risk population, HFNC provided relatively low rates of intra-procedural and immediate post-procedural complications when used to facilitate bronchoscopy. However, inpatient complication rates were higher than outpatient complication rates, possibly reflecting the severity of the underlying illness. More data is needed to better select the patient population that will most benefit from HFNC during bronchoscopy. This abstract is funded by: None
Cheng et al. (Fri,) studied this question.