High-flow nasal oxygen therapy via a single-prong cannula interface during bronchoscopy in patients with acute respiratory failure: a two-center, open-label, randomized controlled trial - 05/05/26

Doi : 10.1016/j.aicoj.2026.100081

Rui Wang ^a,⁎ , Yu Zhao ^a, Ning Lan ^b, Wancong Wang ^c, Xiao Tang ^a, Ting Li ^a, Xiaoqin Liu ^c, Haichao Li ^a, Li Meng ^a, Zhi Xu ^c, Li Wang ^a, Bing Sun ^a, Guifen Gan ^c

^a Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, China

^b Xi'an Center for Disease Control and Prevention, No. 599 Yanta District, Xi'an, Shaanxi Province, China

^c Department of Critical Care Medicine, Affiliated Hospital of Qinghai University, No. 29 Tongren Road, Chengdong District, Xining, Qinghai Province, China

^⁎ Corresponding author.

connectez-vous ou créez un compte

Bienvenue sur EM-consulte, la référence des professionnels de santé.
Article gratuit.

Connectez-vous pour en bénéficier!

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Tuesday 05 May 2026
Cet article a été publié dans un numéro de la revue, cliquez ici pour y accéder

Abstract

Background

Flexible bronchoscopy (FB) is commonly performed in patients with acute respiratory failure (ARF), but the procedure can exacerbate hypoxemia and increase the need for respiratory support. The impact of high-flow nasal oxygen (HFNO) therapy during nasal FB in patients with ARF remains uncertain, as prior studies have focused primarily on oxygenation rather than clinical outcomes. We aimed to evaluate whether HFNO therapy via a single-prong cannula interface (HFNO-SPC) could reduce the need for respiratory support escalation within 24 h after FB compared to standard oxygen therapy (SOT).

Methods

We conducted a two-center, open-label, randomized controlled trial comparing HFNO-SPC to SOT in patients undergoing FB. The primary outcome was escalation of respiratory support within 24 h after FB, defined as the requirement for invasive mechanical ventilation (IMV), noninvasive ventilation (NIV), or HFNO, or as increases in support parameters without changing the mode of respiratory support. The secondary outcome was a hierarchical composite of these escalation events. Electrical impedance tomography (EIT) monitoring was performed during FB to assess tidal volume and end-expiratory lung volume changes.

Results

A total of 160 patients were randomized to either the HFNO-SPC group (n = 80) or the SOT group (n = 80), and all were included in the intention-to-treat analysis. HFNO-SPC significantly reduced the incidence of respiratory support escalation compared to SOT (15.0% vs. 33.8%, P = 0.006). Hierarchical analysis of the composite secondary outcome supported the primary findings (31.6% vs 12.1%, P = 0.004). Additionally, HFNO-SPC resulted in a lower intubation rate within 24 h (7.5% vs. 20.0%, P = 0.022). EIT measurements showed smaller reductions in tidal impedance variation (TIV) during FB and less pronounced changes in end-expiratory lung impedance (ΔEELI) during and after FB in the HFNO-SPC group.

Conclusions

In patients with ARF, HFNO-SPC significantly reduced the proportion of patients requiring respiratory support escalation within 24 h after FB compared with SOT. This finding was consistent across a hierarchical analysis of clinically ranked outcomes.

Trial Registration

ClinicalTrials.Gov: NCT 05759832. Registered 27 February 2023.

Le texte complet de cet article est disponible en PDF.

Keywords : High-flow nasal oxygen therapy, Single-prong cannula interface, Flexible bronchoscopy, Acute respiratory failure, Standard oxygen therapy

Abbreviations : FB, ARF, RCTs, NIV, HFNO, COPD, SpO ₂ , EIT, EELV, SOT, LFNO, HFNO-SPC, ICUs, IMV, PaO ₂ /FiO ₂ , APACHE II, SOFA, ECG, RASS, BAL, TIV, ΔEELI, IPAP, EPAP, Cis, V/Q, VILI, P-SILI, PaCO ₂ , PtCO ₂