High-flow nasal oxygen versus standard care during flexible bronchoscopy in children under general anaesthesia - the...

Hypoxaemia occurs in approximately 30% of children undergoing anaesthesia for flexible bronchoscopy. Nasal high-flow oxygen (NHF) can prolong safe apnoea time and be used in children with abnormal airways. During flexible bronchoscopy, there is limited evidence that NHF may confer advantages over the current standard practice in avoiding hypoxaemia. This study aimed to evaluate the feasibility of recruitment to a protocol investigating NHF during anaesthesia for flexible bronchoscopy, with the objective of reducing rescue oxygenation and hypoxaemia.

The BUFFALO study was a bi-centre, unmasked, randomised, controlled, parallel-group pilot trial comparing NHF techniques with standard practice during anaesthesia. Children aged >37 weeks gestational age to 16 years presenting for elective bronchoscopy were randomised to NHF or standard-care oxygen post-induction of anaesthesia. Outcomes included the feasibility of recruitment, hypoxaemic events, rescue oxygenations, adherence to trial procedures, acceptability of the intervention, and completion rates of data collection methods.

Of the 707 children screened, 89 children were eligible, 81 children were recruited, 43 to the NHF, and 38 to the standard care group. The feasibility outcomes were: proportion of eligible children recruited 91% (95%CI [85,97]), protocol adherence 93% (95%CI [87,98]), and completion rate 100%.

The technique of using NHF during flexible bronchoscopies in children and the protocol for this trial were feasible in the two participating centres. However, respiratory physicians' hesitancy to use this technique in high-risk children and concerns about the potential for translocation of upper airway infectious material into the lower airways reduced the number of eligible patients.