{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:25:47Z","timestamp":1787243147939,"version":"build-2736575974"},"reference-count":16,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T00:00:00Z","timestamp":1770076800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Respiratory Care"],"published-print":{"date-parts":[[2026,5]]},"abstract":"\n Background:<\/jats:title>\n High-flow nasal cannula (HFNC) reduces dead-space ventilation, but this effect is diminished by open-mouth breathing and partial airway obstruction. Consequently, it is uncertain whether HFNC provides respiratory support\u00a0during endobronchial ultrasound (EBUS) procedures.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A single-center randomized controlled crossover study was conducted at the Rijnstate Hospital, Arnhem, the Netherlands, from November 2022 to August 2024.<\/jats:p>\n Patients with severe COPD (Gold III\/IV) were evaluated to determine if HFNC reduces dead space ventilation during an EBUS procedure. Exclusion criteria were known neurodegenerative conditions, allergies to propofol or esketamine, pregnancy, upper-airway obstructions, or severe pulmonary hypertension.<\/jats:p>\n Subjects\u00a0received two sequences of HFNC flow (30 and 70\u2009L\/min or vice versa) during EBUS.<\/jats:p>\n \n The primary outcome was CO\n 2<\/jats:sub>\n washout, determined by a 60-s capnography trace with and without HFNC flow to measure the difference in inspiratory, end-tidal CO\n 2<\/jats:sub>\n , and \u03b2-angle.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Twenty subjects with severe COPD (Gold III\/IV) were included (Group A\n n<\/jats:italic>\n = 10; Group B\n n<\/jats:italic>\n = 10), of which one could not complete the bronchial measurements because of an obstructing carcinoma. CO\n 2<\/jats:sub>\n washout at carina was observed at\u00a070\u2009L\/min of HFNC flow, demonstrated by a reduced inspiratory CO\n 2<\/jats:sub>\n of mean 6.0\u2009mm\u2009Hg (95% CI: 4.5\u20138.3,\n P<\/jats:italic>\n < .001) and end-tidal CO\n 2<\/jats:sub>\n of 5.3\u2009mm\u2009Hg (95% CI: 2.3\u20137.5,\n P<\/jats:italic>\n = .002), but not at 30\u2009L\/min of HFNC flow (mean inspiratory CO\n 2<\/jats:sub>\n difference of 1.5\u2009mm\u2009Hg (95% CI: \u22122.3 to 6.0,\n P<\/jats:italic>\n = .69) and mean end-tidal CO\n 2<\/jats:sub>\n difference of 0.8\u2009mm\u2009Hg (95% CI: \u22122.3 to 3.0,\n P<\/jats:italic>\n = .35). A flow of 70\u2009L\/min reduced inspiratory CO\n 2<\/jats:sub>\n in the left main bronchus (mean = 5.3\u2009mm\u2009Hg; 95% CI: 2.3\u20138.3,\n P<\/jats:italic>\n < .001), but not the end-tidal CO\n 2<\/jats:sub>\n (mean = 3.0\u2009mm\u2009Hg; 95% CI: 0.0\u20136.0,\n P<\/jats:italic>\n = .07).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n An HFNC flow of 70\u2009L\/min reduced\u00a0dead-space ventilation in subjects\u00a0with severe COPD undergoing EBUS procedures during deep sedation, suggesting respiratory support\u00a0during this procedure.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/19433654251412342","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T12:07:39Z","timestamp":1770120459000},"page":"453-459","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["High-Flow Nasal Cannula Reduces Ventilatory Requirements During Endobronchial Ultrasound"],"prefix":"10.1177","volume":"71","author":[{"given":"Jeffrey","family":"Miechels","sequence":"first","affiliation":[{"name":"Mr. Miechels is affiliated with the Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels J.M.","family":"Claessens","sequence":"additional","affiliation":[{"name":"Dr. Claessens is affiliated with the Department of Pulmonology, Rijnstate Hospital, Arnhem, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark V.","family":"Koning","sequence":"additional","affiliation":[{"name":"Dr. Koning is affiliated with the Department of Anesthesiology and Critical Care, Rijnstate Hospital, Arnhem, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,3]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004984"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.10.036"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11113180"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/2040622320920106"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.04577"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2017.11.010"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12630-020-01884-1"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00934.2014"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.00584.2016"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04361-5"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/C2017-0-04059-4"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01617719"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-200010000-00038"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0006-2952(75)90009-x"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/imj.15001"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/7820041"}],"container-title":["Respiratory Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654251412342","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/19433654251412342","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/19433654251412342","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:49:05Z","timestamp":1787240945000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/19433654251412342"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,3]]},"references-count":16,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1177\/19433654251412342"],"URL":"https:\/\/doi.org\/10.1177\/19433654251412342","relation":{},"ISSN":["1943-3654","1943-3654"],"issn-type":[{"value":"1943-3654","type":"print"},{"value":"1943-3654","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,3]]}}}