Flexible Bronchoscopy in a Patient With Pneumomediastinum and Hypoxemic Respiratory Failure: High-Flow Nasal Cannula to the Rescue

Flexible bronchoscopy with bronchoalveolar lavage carries a significant risk of hypoxia in patients with acute hypoxemic respiratory failure. Noninvasive positive pressure ventilation and high-flow nasal cannula are the most commonly used modalities for reducing procedure-related hypoxemia in such patients. There is no guideline on how to safely perform a bronchoscopy in patients with spontaneous pneumomediastinum and hypoxemic respiratory failure. Here we describe a case of bilateral necrotizing pneumonia, spontaneous pneumomediastinum, and moderate acute respiratory distress syndrome who required diagnostic flexible bronchoscopy.