High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial

Lin, Yuxuan; Zhang, Xiaoqing; Liu, Lizhi; Wei, Mengyun; Zhao, Bin; Wang, Xiaojing; Pan, Zhiying; Tian, Jie; Yu, Weifeng; Su, Diansan

doi:10.1016/j.gie.2019.06.033

Cited by 93 publications

(183 citation statements)

References 43 publications

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“…In another trial gas flow rates of 60 L/min compared to 40 L/min were more effective in raising the PaO 2 /FiO 2 ratio at similar FiO 2 in adults undergoing bronchoscopy. 14 Similar results by Lin et al 13 found a decreased incidence of hypoxia in a large cohort of adult patients undergoing procedural sedation for gastroscopy when 30 to 60 L/min of oxygen were applied by HFNC compared to 2 L/min of oxygen via LFNC.…”

Section: Discussionmentioning

confidence: 67%

High‐flow nasal cannula vs standard respiratory care in pediatric procedural sedation: A randomized controlled pilot trial

Klotz

Baumgartner

Teufel

2020

Pediatric Pulmonology

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Introduction Respiratory instability is frequently observed during pediatric procedural sedation. The aim of this trial was to estimate the impact of high‐flow nasal cannula (HFNC) therapy on respiratory stability during sedation for upper gastrointestinal tract endoscopy in children. Methods Prospective randomized controlled non‐blinded single‐center pilot trial. Children were randomly allocated to receive either HFNC (2 L/kg/min) or low‐flow nasal oxygen cannula (LFNC, standard care). FiO2 was titrated to maintain SpO2 94% to 98% in both groups. Primary outcome was the number of events of respiratory instability defined by prespecified criteria (hypoxia, hypercapnia, apnea). Secondary outcomes included type and duration of events, number of interventions to regain respiratory stability and cumulative doses of medication. Results Fifty children (mean age, 12.3 ± 3.1 years) were enrolled and treated with HFNC (n = 25) or LFNC (n = 25). Patient and intervention characteristics were not different in the two study groups, including total oxygen flow rate. Mean (SD) number of respiratory events in the HFNC group was 2.0 ± 1.9 events compared to 2.0 ± 1.4 events in the LFNC group (P = .65; 95% CI of difference, −1.0 to 1.0). There was no difference for any secondary outcome criteria, percentage of patients for any outcome criteria and no difference in the number of respiratory events or airway management maneuvers per patient between treatment groups. Conclusions HFNC did not increase respiratory stability in sedated children undergoing upper gastrointestinal tract endoscopy compared to LFNC.

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Section: Discussionmentioning

confidence: 67%

High‐flow nasal cannula vs standard respiratory care in pediatric procedural sedation: A randomized controlled pilot trial

Klotz

Baumgartner

Teufel

2020

Pediatric Pulmonology

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“…In a prior adult study, HFNC oxygen therapy was reported to be superior to nasal cannula for gastroscopy 8 . However, it should be noted that in this particular study, HFNC oxygen therapy at 60 L/min with F I O 2 at 1.0 was compared to nasal cannula at 2 L/min and the study required a sample size of nearly 2000 to show superiority of HFNC over conventional nasal cannula 7 .…”

mentioning

confidence: 80%

“…So far, six randomized controlled trials have been published on the use of HFNC oxygen therapy during endoscopy, 5‐10 all of which only included adult patients. Three were during bronchoscopy, 5‐7 while the other three were during esophagogastroduodenoscopy or colonoscopy 8‐10 . The latter three studies included patients with healthy lungs and normal oxygenation before examination.…”

mentioning

confidence: 99%

Defining the optimal role of high‐flow nasal cannula in pediatric procedural sedation

Scott

Lee

2020

Pediatric Pulmonology

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“…As in the study by Lin et al , hypercapnia is not monitored. To limit the risk of hypercapnia in our study, the FiO 2 is set at 50% with a flow at 70 L/min 44…”

Section: Methods and Analysismentioning

confidence: 99%

“…In a recent multicentre randomised trial in 1994 patients, HFNO (FiO 2 100% and gas flow from 30 to 60 L/min) significantly decreased the incidence of hypoxaemia (from 8.4% to 0%) compared with SOT (2 L/min with nasal cannula) in healthy (ASA I and II) patients during gastroscopy 44. These results were also found in a recent single-centre randomised trial which showed that HFNO decreased hypoxaemic events compared with SOT during upper GIE in healthy patients (ASA I and II) 45.…”

Section: Introductionmentioning

confidence: 94%

High-flow nasal oxygenation versus standard oxygenation for gastrointestinal endoscopy with sedation. The prospective multicentre randomised controlled ODEPHI study protocol

et al. 2020

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IntroductionHypoxaemia is a major complication during gastrointestinal endoscopy (GIE) procedures (upper/lower) when performed under deep sedation in the procedure room. Standard oxygen therapy (SOT) is used to prevent hypoxaemia. Data suggest that risk factors for hypoxaemia under deep sedation during GIE are obstructive sleep apnoea syndrome, a body mass index above 30 kg/m², high blood pressure, diabetes, heart disease, age over 60 years old, high American Society of Anesthesiologists physical status class and the association of upper and lower GIE. High-flow nasal oxygenation (HFNO) may potentially improve oxygenation during GIE under deep sedation. We hypothesised that HFNO could decrease the incidence of hypoxaemia in comparison with SOT.Methods and analysisThe ODEPHI (High-flow nasaloxygenation versus standardoxygenation for gastrointestinalendoscopy withsedation. The prospective multicentre randomised controlled) study is a multicentre randomised controlled trial comparing HFNO to SOT during GIE (upper and/or lower) under deep sedation administered by anaesthesiologists in the procedure room. Three hundred and eighty patients will be randomised with a 1:1 ratio in two parallel groups.The primary outcome is the occurrence of hypoxaemia, defined by a pulse oximetry measurement of peripheral capillary oxygen saturation (SpO2) below or equal to 92% during the GIE procedure. Secondary outcomes include prolonged hypoxaemia, severe hypoxaemia, need for manoeuvres to maintain upper airway patency and other adverse events.Ethics and disseminationThis study has been approved by the ethics committee (CPP Sud Est Paris V, France), and patients are included after informed consent. The results will be submitted for publication in peer-reviewed journals. As provided for by French law, patients participating in the study are informed that they have the possibility to ask the investigators, once the study is completed, to be informed of the overall results of the study. Thus, a summary of the results will be sent by post to the participants on request.Trial registration numberClinicalTrials.gov Registry (NCT03829293).

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High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial

Cited by 93 publications

References 43 publications

High‐flow nasal cannula vs standard respiratory care in pediatric procedural sedation: A randomized controlled pilot trial

High‐flow nasal cannula vs standard respiratory care in pediatric procedural sedation: A randomized controlled pilot trial

Defining the optimal role of high‐flow nasal cannula in pediatric procedural sedation

High-flow nasal oxygenation versus standard oxygenation for gastrointestinal endoscopy with sedation. The prospective multicentre randomised controlled ODEPHI study protocol

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