Comparison of high-flow nasal cannula and conventional oxygen therapy for high-risk patients during bronchoscopy examination: protocol for a randomized controlled trial.

INTRODUCTION: High-flow nasal cannula (HFNC) has been proven to improve oxygenation and avoid intubation in hypoxemic patients. It has also been utilized during endoscopy examination to reduce the incidence of hypoxia. However, little is known about the effects of HFNC versus conventional oxygen therapy (COT) on oxygenation during bronchoscopy examination via nasal route; particularly, no study has compared the use of HFNC with that of COT at similar FIO2 for patients who have high-risk factors of desaturation during bronchoscopy examination. METHODS AND ANALYSIS: This randomized controlled trial will be implemented in four academic centers in China. Patients who have high-risk factors including hypoxemia, hypercapnia, morbid obesity, and narrow airway will be enrolled to use HFNC or COT during bronchoscopy examination. In the HFNC group, the initial gas flow will be set at 50 L/min with a fraction of inspired oxygen (FIO2) at 0.45, if the patient tolerates, the flow can be increased to 60L/min at most, while in the COT group, oxygen flow will be set at 6 L/min via a conventional nasal cannula. After 5 min pre-oxygenation, the bronchoscope will be inserted via the nasal route. Vital signs, oxygenation (SpO2), and transcutaneous CO2 (PtCO2) will be continuously monitored. The primary outcome is the incidence of hypoxemia, defined as SpO2 < 90% for 10 s during bronchoscopy examination, and secondary outcomes include the need for treatment escalation and adverse events. DISCUSSION: Hypoxia is a common complication of bronchoscopy, our study attempted to demonstrate that HFNC may reduce the probability of hypoxia during bronchoscopy in high-risk patients. The results will be disseminated through peer-reviewed journals and national and international conferences. TRIAL REGISTRATION: http://www.chictr.org.cn/ : ChiCTR2100055038. Registered on 31 December 2021.

Pulmonary rehabilitation after lung transplantation with severe complications: A case report.

This case study describes a 59-year-old male with a body mass index of 14.4 kg/m2 and a diagnosis of interstitial lung disease, pneumoconiosis, and severe pulmonary hypertension who received a bilateral lung transplant in a hospital in mainland China. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was initiated before the lung transplant; in addition, an emergency thoracotomy was performed three hours afterwards due to uncontrolled bleeding. VA-ECMO was weaned 34 hours later, but weaning from the ventilator failed multiple times due to bilateral pneumothorax, weak neuromuscular drive, and muscle strength. A full, personalized rehabilitation program was initiated with the help of a respiratory therapy team and the physician, drawing on the American Thoracic Society/European Respiratory Society Statement on Pulmonary Rehabilitation. This included nutrition support, draining air from the chest pleural cavity, aggressive bronchial-hygiene therapy, a weaning plan, breathing and physical exercises, and psychological support. Eighty-one days after the tracheotomy, the patient was successfully weaned, decannulated, and discharged. A careful, ongoing evaluation and a personalized program assisted with weaning this difficult patient.