High-flow Nasal Cannula versus Conventional Ventilation in Laryngeal Surgery: A Systematic Review and Meta-analysis

Abstract

High-flow nasal cannula (HFNC) is an emerging option for maintaining oxygenation in patients undergoing laryngeal surgery, as an alternative to traditional tracheal ventilation and jet ventilation (JV). However, the data on its safety and efficacy is sparse. This study aims to aggregate the current data and compares the use of HFNC with tracheal intubation and jet ventilation in adult patients undergoing laryngeal surgery. We searched PubMed, MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), Embase (Excerpta Medica Database), Google Scholar, Cochrane Library, and Web of Science. Both observational studies and prospective comparative studies were included. Risk of bias was appraised with the Cochrane Collaboration Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) or RoB2 tools and the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for case series. Data were extracted and tabulated as a systematic review. Summary statistics were performed. Meta-analyses and trial sequential analyses of the comparative studies were performed. Forty-three studies (14 HFNC, 22 JV, and seven comparative studies) with 8064 patients were included. In the meta-analysis of comparative studies, the duration of surgery was significantly reduced in the THRIVE (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange) group, but the number of desaturations, need for rescue intervention, and peak end-tidal CO 2 were significantly increased compared to the conventional ventilation group. The evidence was of moderate certainty and there was no evidence of publication bias. In conclusion, HFNC may be as effective as tracheal intubation in oxygenation during laryngeal surgery in selected adult patients and reduces the duration of surgery but conventional ventilation with tracheal intubation may be safer. The safety of JV was comparable to HFNC.

HFNO for laryngotracheal surgery; when is it worthwhile?

“…A recent systematic review and meta-analysis that considered 14 studies of HFNO for laryngeal surgery reported a median desaturation of 8.1% and a need for rescue intervention in 14.2% 2 …”

Oxygenation during Endobronchial Ultrasound

“…In cases where the upper airways are shared fully or partially like during bronchoscopy, laryngeal surgeries or dental procedures, the use of HFNO has yielded effective oxygenation. [5][6][7][8][9] A systematic review showed that HFNO is effective in reducing the incidence of hypoxaemia, requirement of minor airway manoeuvres and procedure interruptions during sedation. 4 Currently, endobronchial ultrasound (EBUS) and transbronchial sampling have moved from the interventional pulmonology domain to the regular respirology practice.…”