Fibroscopy in patients with hypoxemic respiratory insufficiency: Utility of the high-flow nasal cannula

Summary 

We report the first case of a patient with severe acute respiratory failure who underwent fibrobronchoscopy with oxygen administration provided by high-flow nasal cannula.

We present the case of a patient with severe myasthenia gravis who was admitted to the Department of Intensive Care Medicine of our hospital with severe acute respiratory failure. The muscle weakness inherent to the patient's underlying condition made expectoration of respiratory secretions difficult and led to the development of bilateral atelectasis. Non-invasive mechanical ventilation sessions were established, but there was no significant clinical improvement; hence, oxygen administration by humidified high-flow nasal cannula (Optiflow™, Fisher & Paykel, New Zealand) was decided. The patient experienced a subjective improvement, a decrease in respiratory rate, and an improvement in oxygenation, which, following appropriate premedication, allowed diagnostic–therapeutic bronchoscopy to be performed at bedside, without requiring endotracheal intubation or mechanical ventilation for the procedure.

The improvement experienced by the patient with high-flow nasal cannula, following appropriate premedication, allowed diagnostic–therapeutic bronchoscopy to be performed.

Keywords: Oxygen therapy, Respiratory failure, Hypoxia, Myasthenia gravis, Bronchoscopy