{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:12:27Z","timestamp":1779358347654,"version":"3.51.4"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T00:00:00Z","timestamp":1779321600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007771","name":"Silesian Medical University","doi-asserted-by":"publisher","award":["BNW-1-118\/N\/4\/K"],"award-info":[{"award-number":["BNW-1-118\/N\/4\/K"]}],"id":[{"id":"10.13039\/100007771","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Fiberoptic bronchoscopy (FOB) is a procedure routinely performed in clinical practice for both diagnostic and therapeutic purposes. FOB frequently impairs respiratory function, which may exacerbate respiratory failure. Currently, conventional oxygen therapy (COT) is the most commonly used form of respiratory support; however, non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) are being used increasingly. The optimal settings and indications for NIV and HFNC in patients with respiratory acidosis undergoing FOB have not yet been determined. Methods: This is a prospective, multicenter, randomized controlled trial including two parallel study populations defined by the indication for bronchoscopy and the type of respiratory acidosis. Therapeutic FOB (Study 1): Patients with decompensated type 2 respiratory failure (pH &lt; 7.35 and PaCO2 &gt; 45 mmHg) will be randomized to receive one of four methods of respiratory support during bronchoscopy: COT, NIV, HFNC, or invasive mechanical ventilation (IMV) (n = 315). Diagnostic FOB (Study 2): Patients with chronic respiratory acidosis (pH \u2265 7.35, PaCO2 &gt; 45 mmHg, and\/or HCO3\u2212 &gt; 27 mmol\/L) will be randomized to receive COT, NIV, or HFNC during bronchoscopy (n = 210). Before FOB, patients in both groups will undergo arterial blood gas (ABG) analysis. During FOB, vital signs will be continuously monitored, including SpO2, FiO2, TcCO2, ECG, and heart rate. After FOB, ABG analysis will be repeated, and study endpoints and complications, if any, will be recorded. The planned study period is from April 2026 to April 2029. Results: Based on the study results, we aim to evaluate the effectiveness and safety of different respiratory support strategies during flexible bronchoscopy, with the primary objective of comparing the rate of treatment failure among COT, HFNC, NIV, and IMV. Treatment failure is defined as the need for endotracheal intubation, premature termination of the procedure, or escalation of respiratory support. Additionally, we aim to identify the optimal NIV and HFNC settings, as well as complication rates in both study groups. Conclusions: The results of this study will help define the role of optimal respiratory support in patients with respiratory acidosis undergoing FOB, potentially leading to a shorter time from admission to diagnosis, better tolerance of the procedure, and faster recovery afterward.<\/jats:p>","DOI":"10.3390\/jcm15103960","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T09:29:58Z","timestamp":1779355798000},"page":"3960","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Assessment of Conventional Oxygen Therapy, High-Flow Nasal Cannula, and Non-Invasive Ventilation to Secure Bronchofiberoscopy in Patients with Respiratory Acidosis: A Narrative Review and a Proposal for a Protocol in View of a Randomized Multicenter Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-4825-9330","authenticated-orcid":false,"given":"Miko\u0142aj","family":"Rycerski","sequence":"first","affiliation":[{"name":"Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Warcholi\u0144ski","sequence":"additional","affiliation":[{"name":"ATEMIDA Sp. Z o.o., 40-875 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Micha\u0142","family":"Zieli\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6970-7202","authenticated-orcid":false,"given":"Federico","family":"Longhini","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, Anesthesia and Intensive Care, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mrinal","family":"Sircar","sequence":"additional","affiliation":[{"name":"Pulmonology and Critical Care Fortis Hospital, NOIDA Sector 62, Noida 201301, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9397-6963","authenticated-orcid":false,"given":"Aleksandra","family":"Oraczewska","sequence":"additional","affiliation":[{"name":"Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Magdalena","family":"Latos","sequence":"additional","affiliation":[{"name":"Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrycja","family":"Rzepka-Wrona","sequence":"additional","affiliation":[{"name":"Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5923-2469","authenticated-orcid":false,"given":"Szymon","family":"Bia\u0142ka","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0716-6471","authenticated-orcid":false,"given":"Grzegorz","family":"Bro\u017cek","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1796-7659","authenticated-orcid":false,"given":"Szymon","family":"Skoczy\u0144ski","sequence":"additional","affiliation":[{"name":"Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, 41-803 Zabrze, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,21]]},"reference":[{"key":"ref_1","first-page":"e11122","article-title":"Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications","volume":"12","author":"Qanash","year":"2020","journal-title":"Cureus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1136\/thoraxjnl-2013-203618","article-title":"British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: Accredited by NICE","volume":"68","author":"Blaikley","year":"2013","journal-title":"Thorax"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"646","DOI":"10.4187\/respcare.04456","article-title":"Flexible Bronchoscopy Is Safe and Effective in Adult Subjects Supported with Extracorporeal Membrane Oxygenation","volume":"61","author":"Sharma","year":"2016","journal-title":"Respir. Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.ccm.2017.09.004","article-title":"Sedation in Bronchoscopy: A Review","volume":"39","author":"McCambridge","year":"2018","journal-title":"Clin. Chest Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.advms.2023.10.011","article-title":"The use of non-invasive respiratory assistance to facilitate bronchofiberoscopy performance in patients with hypoxemic (type one) respiratory failure\u2014Study protocol","volume":"68","author":"Oraczewska","year":"2023","journal-title":"Adv. Med. Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1097\/CCM.0b013e31829e53dc","article-title":"Effects of propofol on patient-ventilator synchrony and interaction during pressure support ventilation and neurally adjusted ventilatory assist","volume":"42","author":"Vaschetto","year":"2014","journal-title":"Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.resp.2017.06.007","article-title":"Remifentanil effects on respiratory drive and timing during pressure support ventilation and neurally adjusted ventilatory assist","volume":"244","author":"Costa","year":"2017","journal-title":"Respir. Physiol. Neurobiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1007\/5584_2019_375","article-title":"Noninvasive Ventilation-Facilitated Bronchofiberoscopy in Patients with Respiratory Failure","volume":"1160","author":"Minarowski","year":"2019","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.advms.2021.04.001","article-title":"Risk factors of complications during noninvasive mechanical ventilation -assisted flexible bronchoscopy","volume":"66","author":"Ogonowski","year":"2021","journal-title":"Adv. Med. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Corral-Blanco, M., Sayas-Catal\u00e1n, J., Hern\u00e1ndez-Voth, A., Rey-Terr\u00f3n, L., and Villena-Garrido, V. (2023). High-Flow Nasal Cannula Therapy as an Adjuvant Therapy for Respiratory Support during Endoscopic Techniques: A Narrative Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010081"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1007\/s00134-024-07386-8","article-title":"High-flow nasal cannula: Evolving practices and novel clinical and physiological insights","volume":"50","author":"Roca","year":"2024","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/j.advms.2023.10.009","article-title":"May noninvasive mechanical ventilation and\/or continuous positive airway pressure increase the bronchoalveolar lavage salvage in patients with pulmonary diseases? Randomized clinical trial\u2014Study protocol","volume":"68","author":"Danel","year":"2023","journal-title":"Adv. Med. Sci."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1378\/chest.121.4.1149","article-title":"Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy","volume":"121","author":"Antonelli","year":"2002","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1186\/s12931-021-01846-1","article-title":"Oxygenation strategies during flexible bronchoscopy: A review of the literature","volume":"22","author":"Pelaia","year":"2021","journal-title":"Respir. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1513\/AnnalsATS.202410-1109OC","article-title":"Comparison of High-Flow Nasal Cannula and Conventional Oxygen Therapy for High Risk Patients During Bronchoscopy Examination: A Multicenter Randomized Controlled Trial","volume":"22","author":"Qin","year":"2025","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e001524","DOI":"10.1136\/bmjresp-2022-001524","article-title":"Efficacy of different respiratory supports to prevent hypoxia during flexible bronchoscopy in patients of COPD: A triple-arm, randomised controlled trial","volume":"10","author":"Sharma","year":"2023","journal-title":"BMJ Open Respir. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1097\/EJA.0000000000001166","article-title":"Noninvasive respiratory support in the hypoxaemic peri-operative\/periprocedural patient: A joint ESA\/ESICM guideline","volume":"37","author":"Leone","year":"2020","journal-title":"Eur. J. Anaesthesiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"276","DOI":"10.4046\/trd.2020.0002","article-title":"Risk Factors for Predicting Hypoxia in Adult Patients Undergoing Bronchoscopy under Sedation","volume":"83","author":"Choi","year":"2020","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1186\/s13054-014-0712-9","article-title":"High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy\u2014A prospective randomised trial","volume":"18","author":"Simon","year":"2014","journal-title":"Crit. Care"},{"key":"ref_20","first-page":"S38","article-title":"Barotrauma and pneumothorax","volume":"7","author":"Ioannidis","year":"2015","journal-title":"J. Thorac. Dis."},{"key":"ref_21","unstructured":"(2025, March 25). WMA Declaration of Helsinki\u2014Ethical Principles for Medical Research Involving Human Participants. Available online: https:\/\/www.wma.net\/policies-post\/wma-declaration-of-helsinki\/."},{"key":"ref_22","unstructured":"(2025, March 25). General Data Protection Regulation. Available online: https:\/\/gdpr-info.eu\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1002\/jhm.13416","article-title":"Clinical guideline highlights for the hospitalist: GOLD COPD update 2024","volume":"19","author":"Cornelius","year":"2024","journal-title":"J. Hosp. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1602426","DOI":"10.1183\/13993003.02426-2016","article-title":"Official ERS\/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure","volume":"50","author":"Rochwerg","year":"2017","journal-title":"Eur. Respir. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1159\/000151656","article-title":"Severe complications of bronchoscopy","volume":"76","author":"Jin","year":"2008","journal-title":"Respiration"},{"key":"ref_26","first-page":"306","article-title":"Predictors of oxygen desaturation in patients undergoing diagnostic bronchoscopy","volume":"29","author":"Fang","year":"2006","journal-title":"Chang. Gung Med. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S37","DOI":"10.4103\/lungindia.lungindia_108_19","article-title":"Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society\/National College of chest physicians (I)\/Indian association for bronchology recommendations","volume":"36","author":"Mohan","year":"2019","journal-title":"Lung India"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e20180125","DOI":"10.36416\/1806-3756\/e20180125","article-title":"Early complications in flexible bronchoscopy at a university hospital","volume":"46","author":"Jacomelli","year":"2020","journal-title":"J. Bras. Pneumol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"189","DOI":"10.4103\/2229-5151.164995","article-title":"Complications of bronchoscopy: A concise synopsis","volume":"5","author":"Stahl","year":"2015","journal-title":"Int. J. Crit. Illn. Inj. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1378\/chest.126.5.1552","article-title":"Supplemental oxygen impairs detection of hypoventilation by pulse oximetry","volume":"126","author":"Fu","year":"2004","journal-title":"Chest"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1159\/000515920","article-title":"Hypercapnia in COPD Patients Undergoing Endobronchial Ultrasound under Local Anaesthesia and Analgosedation: A Prospective Controlled Study Using Continuous Transcutaneous Capnometry","volume":"100","author":"Galetin","year":"2021","journal-title":"Respiration"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Pagliaro, R., Aronne, L., Fomez, R., Ferri, V., Montella, A., Sanduzzi Zamparelli, S., Bianco, A., and Perrotta, F. (2024). High-Flow Nasal Cannula System in Respiratory Failure Associated with Interstitial Lung Diseases: A Systematic Review and Narrative Synthesis. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102956"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Panzuti, G., Pisani, L., and Nava, S. (2025). Bridging the Gap: The Role of Non-Invasive Respiratory Supports in Weaning from Invasive Mechanical Ventilation. J. Clin. Med., 14.","DOI":"10.3390\/jcm14207443"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Chao, W.-C., Wang, S.-Y., Lin, C.-Y., Chang, H.-T., Su, W.-L., Tseng, C.-H., Yang, K.-Y., Ku, S.-C., Kao, K.-C., and Wang, C.-J. (2025). High-Flow Nasal Cannula Application After Extubation in Acute Respiratory Failure Patients. J. Clin. Med., 14.","DOI":"10.3390\/jcm14093087"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1136\/thoraxjnl-2021-217116","article-title":"High-flow nasal cannula oxygen therapy for outpatients undergoing flexible bronchoscopy: A randomised controlled trial","volume":"77","author":"Longhini","year":"2022","journal-title":"Thorax"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Tsai, Y.-C., Liu, S.-F., Chang, H.-C., Huang, C.-M., Hsieh, W.-C., Li, C.-L., Lin, T.-L., and Kuo, H.-C. (2025). Tailored Predictive Indicators for Weaning Success from High-Flow Nasal Cannula in Postoperative Hypoxemic Patients. Life, 15.","DOI":"10.3390\/life15020312"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"363","DOI":"10.5005\/jp-journals-10071-23219","article-title":"Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients","volume":"23","author":"Sircar","year":"2019","journal-title":"Indian J. Crit. Care Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3960\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T10:02:06Z","timestamp":1779357726000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3960"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,21]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103960"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103960","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,21]]}}}