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

Abstract

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.

High flow nasal cannula versus standard low flow nasal oxygen during flexible bronchoscopy in children: A randomized controlled trial

“…A recent RCT comparing HFNC with NC during procedural sedation in children found no difference in the number of respiratory events during gastrointestinal endoscopy. 27 It is a pilot study and it cannot be affirmed that there is no benefit with the application of HFNC since desaturation is a rare event during digestive endoscopy and the number of patients necessary to observe the effect of the intervention has not been estimated. It cannot rule out the beneficial effect of HFNC in a larger cohort of patients or in procedures other than upper endoscopy with a significant air leakage through the mouth.…”

High‐flow nasal cannula during flexible bronchoscopy: Is it effective in children?

“…High‐flow nasal cannula (HFNC) is increasingly used for respiratory support during procedural sedation in children 1 . Fiberoptic bronchoscopy (FB) is a common procedure in pediatric pulmonology, and hypoxia is one of the most common complications 2 .…”

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

“…The reduction in the known benefits of HFNC oxygen therapy during an endoscopic procedure probably explain the results of the randomized controlled trial completed by Klotz et al 13 published in this edition of Pediatric Pulmonology . To the best of our knowledge, this is the first study to report on the use of HFNC during endoscopy examinations for pediatric patients (Reference to manuscript when published).…”

“…In their study, they enrolled and treated 25 patients with HFNC and 25 patients with low‐flow nasal cannula that received sedation for an upper gastrointestinal tract endoscopy. More patients in the HFNC group had a higher prevalence of snoring (32% vs. 8%) and rate of first‐hand smoke exposure (24% vs. 0%) 13 . Similar oxygen flow rates (ml/min/kg) were used in both groups, although there were different gas flow rates used (L/min).…”

“…That said, future studies are needed to confirm if this is indeed true. Regardless of the type of oxygen devices used during endoscopic procedures and procedural sedation, close monitoring of patient respiratory status, as well as early identification and treatment of respiratory compromise are crucial 12,13,15 …”