Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) has been shown to prevent desaturation and prolong apnoeic time in the perioperative setting. Previously, pulmonary hypertension was not studied using this technique, due to concern for hypercapnia and resultant transient worsening of mean pulmonary artery pressure. We describe a patient with severe pulmonary hypertension (mean pulmonary artery pressure of 82 mmHg) who underwent bronchoscopy using deep sedation with THRIVE. There were no recorded desaturation events and no post‐operative signs of hypercapnia. This case report demonstrates a novel use of THRIVE in a patient with severe pulmonary hypertension.