High-flow nasal cannula oxygenation in comparison with apnoeic oxygenation during foreign body removal by rigid bronchoscopy: A randomised controlled trial

Abstract

Background and Aims: This trial aimed to assess the safety and efficacy of oxygenation using a high-flow nasal cannula (HFNC) compared with the standard apnoeic oxygenation technique during foreign body (FB) removal by a rigid bronchoscope. Methods: A prospective, blinded, randomised, controlled trial was conducted on subjects planned for FB removal by a rigid bronchoscope. Inclusion criteria were male and female patients aged between 10 and 40 years. The primary outcome was the lowest oxygen saturation level monitored by pulse oximeter during the procedure, and the secondary outcome was the incidence of postoperative atelectasis. Results: Nearly 64 patients were randomised into either HFNC oxygenation ( N = 32) or apnoeic oxygenation ( N = 32) group. There were no significant differences between the studied groups regarding age, gender, weight, or cardiovascular variables. Intraoperative oxygen saturation was 4% higher in the HFNC group at different times. The end-tidal carbon dioxide measured on induction and after termination by 15 min showed no significant differences between the two groups; however, it was significantly higher in the apnoeic oxygenation group immediately after the procedure, after 5 min, and after 10 min of termination. No adverse effects from the increased end-tidal carbon dioxide were reported. Conclusion: HFNC was superior to apnoeic oxygenation technique in maintaining oxygenation status in patients undergoing rigid bronchoscopy for FB removal.

Risk of bias in published randomised controlled trials

“…The demographic data of the 27 included articles are given in Table 1 . [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] Overall, 13 out of 27 were judged as having a low risk of bias. [ 5 6 9 10 12 15 16 20 21 22 23 24 27 ] In contrast, 6 out of 27 had a high risk of bias,[ 4 13 14 25 28 30 ] and 8 out of 27 had some concerns regarding biases.…”

“…[ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 ] Overall, 13 out of 27 were judged as having a low risk of bias. [ 5 6 9 10 12 15 16 20 21 22 23 24 27 ] In contrast, 6 out of 27 had a high risk of bias,[ 4 13 14 25 28 30 ] and 8 out of 27 had some concerns regarding biases. [ 7 8 11 17 18 19 26 29 ] In domain 1, that is, bias arising from the randomisation process, 3 out of 27 had some concerns regarding biases.…”

“…[ 25 28 30 ] Rest of the trials were judged as having a low risk of bias. [ 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 26 27 29 ] In domain 2, that is, bias due to deviations from intended interventions, 7 out of 27 had some concerns regarding biases. [ 5 8 11 13 14 18 29 ] and the remaining trials were judged as having a low risk of bias.…”

Intraoperative Use of High-Flow Nasal Cannula in Elderly Patients Undergoing Hip Fracture Repair Under Spinal Anesthesia: A Randomized Controlled Study

“…The HFNC group exhibited notable advantages in maintaining respiratory parameters throughout the surgical procedure, particularly achieving significantly higher oxygen saturation (SpO 2 ) levels at various points in time. HFNC has also been used as respiratory support in sedated patients undergoing short interventions such as diagnostic and therapeutic bronchoscopy, with encouraging results [21][22][23][24].…”

High-flow nasal oxygen as an adjunct for the safe removal of impacted metallic upper airway foreign bodies

“…A previous randomized controlled trial comparing the use of standard nasal oxygenation with HFNO to allow for apnoeic oxygenation in the removal of foreign bodies during bronchosocopy showed a statistically significant higher level of oxygen saturation and lower level of end tidal carbon dioxide levels in the immediate post-operative period for those in the HFNO group. The use of HFNO has also been shown to have decreased rates of post-operative atelectasis [ 7 ].…”