High-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation in patients at risk of hypoxaemia: a multicentre randomised controlled trial (ODEPHI trial)

Abstract

Background: We aimed to determine whether high-flow nasal oxygen could reduce the incidence of decreased peripheral oxygen saturation (SpO 2 ) compared with standard oxygen in patients at risk of hypoxaemia undergoing gastrointestinal endoscopy under deep sedation. Methods: This was a multicentre, randomised controlled trial with blinded assessment of the primary outcome evaluating high-flow nasal oxygen (gas flow 70 L min À1 , inspired oxygen fraction 0.50) or standard oxygen delivered via nasal cannula or face mask (6 L min À1 ) or nasopharyngeal tube (5 L min À1 ) in patients at risk of hypoxaemia (i.e. >60 yr old, or with underlying cardiac or respiratory disease, or with ASA physical status >1, or with obesity or sleep apnoea syndrome) undergoing gastrointestinal endoscopy. The primary endpoint was the incidence of SpO 2 92%. Secondary outcomes included prolonged or severe desaturations, need for manoeuvres to maintain free upper airways, and other adverse events. Results: In 379 patients, a decrease in SpO 2 92% occurred in 9.4% (18/191) for the high-flow nasal oxygen group, and 33.5% (63/188) for the standard oxygen groups (adjusted absolute risk difference, e23.4% [95% confidence interval (CI), e28.9 to e16.7]; P<0.001). Prolonged desaturation (>1 min) and manoeuvres to maintain free upper airways were less frequent in the high-flow nasal oxygen group than in the standard oxygen group (7.3% vs 14.9%, P¼.02, and 11.1% vs 32.4%, P<0.001). Conclusions: In patients at risk of hypoxaemia undergoing gastrointestinal endoscopy under deep sedation, use of highflow nasal oxygen significantly reduced the incidence of peripheral oxygen desaturation. Clinical trial registration: NCT03829293.

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

“…Another important difference is that in our study, the initial oxygen flow in nasal mask and nasal cannula group was 4 L/min, while in Nay et al 14 study, the oxygen flow was 70 L/min in the HFNC group and 8 L/min in the standard nasal cannula group. These differences could have reduced the incidence of hypoxemia in the Nay et al 14 study compared with ours. However, a disposable HFNC oxygen circuit costs much more than a nasal cannula.…”

“…They found that HFNC oxygenation significantly reduced the incidence of hypoxemia from 22.9% to 5.8% and decreased frequent need for maneuvers to maintain free upper airways (11.1% vs 32.4%) and for increasing oxygen flow (7.9% vs 23.4%). 14 Our study differs from the Nay et al 14 study in that we only enrolled patients having gastroscopy. Another important difference is that in our study, the initial oxygen flow in nasal mask and nasal cannula group was 4 L/min, while in Nay et al 14 study, the oxygen flow was 70 L/min in the HFNC group and 8 L/min in the standard nasal cannula group.…”

“… 14 Our study differs from the Nay et al 14 study in that we only enrolled patients having gastroscopy. Another important difference is that in our study, the initial oxygen flow in nasal mask and nasal cannula group was 4 L/min, while in Nay et al 14 study, the oxygen flow was 70 L/min in the HFNC group and 8 L/min in the standard nasal cannula group. These differences could have reduced the incidence of hypoxemia in the Nay et al 14 study compared with ours.…”

“…The author reported that HFNC oxygenation could reduce the incidence of hypoxemia from 33.1% to 21.2%. Nay et al 14 compared HFNC oxygenation with standard nasal cannula oxygenation in 379 patients having intravenous anesthesia for gastrointestinal endoscopy. They found that HFNC oxygenation significantly reduced the incidence of hypoxemia from 22.9% to 5.8% and decreased frequent need for maneuvers to maintain free upper airways (11.1% vs 32.4%) and for increasing oxygen flow (7.9% vs 23.4%).…”

High Flow Nasal Oxygenation and Indications

“…Girişimler başlamadan önce ve sonrasında HFNC kullanmak desaturasyonu önleyebilir ya da uygulamayı yapan hekime zaman kazandırabilir. Endoskopide (41) ve bronkoskopide (42) HFNC kullanımı ile desatürasyonun azaldığı gösterilmiştir.…”