High-Flow Nasal Cannula Oxygen in Patients Having Anesthesia for Advanced Esophagogastroduodenoscopy: HIFLOW-ENDO, a Randomized Clinical Trial

Abstract

BACKGROUND: Over 6 million esophagogastroduodenoscopy (EGD) procedures are performed in the United States each year. Patients having anesthesia for advanced EGD procedures, such as interventional procedures, are at high risk for hypoxemia. METHODS: Our primary study aim was to evaluate whether high-flow nasal cannula (HFNC) oxygen reduces the incidence of hypoxemia during anesthesia for advanced EGD. Secondarily, we studied whether HFNC oxygen reduces hypercarbia or hypotension. After obtaining written informed consent, adults having anesthesia for advanced EGD, expected to last longer than 15 minutes, were randomly assigned to receive HFNC oxygen or standard nasal cannula (SNC) oxygen. The primary outcome was occurrence of one or more hypoxemia events during anesthesia, defined by arterial oxygen saturation <92% for at least 15 consecutive seconds. Secondary outcomes were occurrence of one or more hypercarbia or hypotension events. A hypercarbia event was defined by a transcutaneous CO2 measurement 20 mm Hg or more above baseline, and a hypotension event was defined by a mean arterial blood pressure measurement 25% or more below baseline. RESULTS: Two hundred seventy-one adult patients were enrolled and randomized, and 262 patients completed study procedures. Eight randomized patients did not complete study procedures due to changes in their anesthesia or endoscopy plan. One patient was excluded from analysis because their procedure was aborted after 1 minute. Patients who received HFNC oxygen (N = 132) had a significantly lower incidence of hypoxemia than those who received SNC oxygen (N = 130; 21.2% vs 33.1%; hazard ratio [HR] = 0.59 [95% confidence interval {CI}, 0.36–0.95]; P = .03). There was no difference in the incidence of hypercarbia or hypotension between the groups. The HR for hypercarbia with HFNC oxygen was 1.29 (95% CI, 0.89–1.88; P = .17), and the HR for hypotension was 1.25 (95% CI, 0.86–1.82; P = .25). CONCLUSIONS: HFNC oxygen reduces the incidence of hypoxemia during anesthesia for advanced EGD and may offer an opportunity to enhance patient safety during these procedures.

The effectiveness of high-flow nasal cannula during sedated digestive endoscopy: a systematic review and meta-analysis

“…The definition of hypoxemia varied among studies. Most included hypoxemia diagnosed with SpO 2 < 90% [ 21 – 24 , 26 ], two studies included hypoxemia diagnosed with SpO 2 < 92% [ 27 , 28 ]. In our subgroup analysis, we included studies in which hypoxemia was defined as SpO 2 < 90%.…”

Comparison of a Nasal Mask and Traditional Nasal Cannula During Intravenous Anesthesia for Gastroscopy Procedures: A Randomized Controlled Trial

“…Besides, nasal mask also significantly decreased the need for maneuvers to maintain free upper airways (8.8% vs 19.1%) and for increasing oxygen flow (15.5% vs 23.8%). The effectiveness of the nasal mask can somewhat be considered similar to the HFNC used in Mazzeffi et al 7 study. The author reported that HFNC oxygenation could reduce the incidence of hypoxemia from 33.1% to 21.2%.…”

“…Previously, studies with small samples reported that high-flow nasal cannula (HFNC) oxygenation and the use of a nasopharyngeal catheter could reduce the incidence of hypoxemia during anesthesia for gastroscopy. [5][6][7] However, those methods require special supplemental oxygen devices or oxygen delivery systems or they induce adverse events such as nasopharyngeal bleeding. 6,7 Therefore, it is critical to find an appropriate method to prevent hypoxemia with fewer side effects during gastroscopy.…”

High-Flow Nasal Oxygen Vs. Standard Oxygen Therapy for Patients Undergoing Transcatheter Aortic Valve Replacement With Conscious Sedation: A Randomised Controlled Trial

“…This may be because patients did not have their mouths closed or this is not seen in sedated patients for another reason. In procedures such as bronchoscopy [12,13], gastroscopy [14,15], endoscopic retrograde cholangiopancreatography [16] in which an improvement in oxygenation with the use of HFNT have been shown, the presence of an endoscope may have produced the same effect as having the mouth closed.…”

“…High-ow nasal oxygen (HFNT) allows the delivery of heated and humidi ed oxygen at an inspiratory fraction of oxygen (FiO 2 ) of between 0.21 to 1.0, in a ow rate of up to 60 l.min -1 [6]. Emerging evidence shows that HFNT is effective in various clinical settings such as in the treatment of acute heart failure [7][8][9], after cardiac surgery [10,11] and during procedural sedation [12][13][14][15][16][17]. Besides providing a higher degree of patient comfort by supplying warmed and humidi ed gas to maintain mucociliary functions [18], it increases pharyngeal pressure by 3 cmH 2 0 and generates an effect similar to continuous airway positive pressure (CPAP) [19].…”