Laryngeal mask airway or high-flow nasal cannula versus nasal cannula for advanced bronchoscopy: a randomised controlled trial

Background Advanced bronchoscopic procedures have become a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy. Methods This three-arm, prospective, block randomised trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound (EBUS) with transbronchial needle aspiration and met inclusion/exclusion criteria. Patients were randomised to undergo bronchoscopy through a laryngeal mask airway (LMA) or with a high-flow nasal cannula (HFNC) or low-flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the three groups, including complications, oxygenation, ventilation and need for intervention. Results Analysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p<0.01). The need for interventions and their number were also lower in the LMA (40%) and HFNC (52.6%) groups compared with the NC group (90%, p<0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of a lower rate of recurrent desaturation events and fewer complications in general compared with NC. Conclusion In this prospective randomised trial, we demonstrated the advantages of using LMA or HFNC over NC during advanced bronchoscopy with EBUS.