Bronchoscopy is an essential procedure for the evaluation and management of various pulmonary pathologies. Many times, it is done on patients with hypoxic or hypercapnic respiratory failure. The procedure is associated with various physiological changes. These changes are exaggerated in patients with respiratory failure, and they depend on the duration of the procedure as well as the number of maneuvers done during the procedure. However, the procedure can be done safely on patients who are on noninvasive ventilation. In this chapter, we describe various changes associated with bronchoscopy as well as provide key recommendations for monitoring. We will discuss various society recommendations as well as our practice to ensure safety during the procedure.