High flow versus conventional nasal cannula for oxygenation and ventilation maintenance during surgery with intravenous deep sedation by propofol: a randomized controlled study

Abstract

Background The dead space washout and provision of some level of positive airway pressure by nasal high-flow (NHF) cannula could improve the efficiency of ventilation, oxygenation and maintenance of the upper airway in patients undergoing deep sedation. This study aimed to compare the incidences of events represented oxygenation and ventilation, i.e. desaturation and upper airway obstruction, and arterial blood gas (ABG) levels between using NHF cannula and conventional nasal cannula (NC2) during deep sedation of adult surgical patients. Methods In this prospective randomized single-blinded study, the patients who were 20–80 years old, ASA physical status of 1 to 3, scheduled for surgery under intravenous sedation (IVS) were included. The patients were randomly divided into two groups, i.e., NC2 or NHF groups. Propofol infusion was given to maintain deep sedation. The desaturation (SpO2 < 92%) and upper airway obstruction events (presence of snoring with paradoxical breathing) after application of NC2 or NHF were observed and collected. Other outcomes included interventions during IVS, such as jaw lifting or airway instrument insertion, mouth dryness, and post- ABG analyses were also collected and compared. Results Thirty-six patients undergoing endovascular surgery were randomized into NC2 or NHF groups (18 in each group). No patients dropped out of the study. There were no significant differences in age, sex, ASA physical status, pre-sedation and pre-application of NC2 and NHF ABG analyses (PaO2, SaO2, pH, PaCO2, and PaO2/FiO2). NHF group had significantly lower in the incidence of desaturation [5 (27.78%) vs 13 (72.22%), p = 0.008], upper airway obstruction [4 (22.22%) vs 13 (72.22%), p = 0.003], and airway maneuver [6 (33.33%) vs 13 (72.22%), p = 0.019] than NC2 group. There were no differences in the ABG analyses after oxygen supplementation and no significant differences in mouth dryness between groups. Conclusion The use of NHF cannula in patients undergoing endovascular surgery under deep sedation reduced desaturation events and required fewer airway interventions than NC2 with no difference in arterial blood gas analyses and mouth dryness.

Effect of high‐flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta‐analysis

“…For the complete analysis see online Supporting Information (Table S1 ). The included studies comprised eight gastrointestinal [ 8 , 9 , 12 , 22 , 34 , 35 , 36 , 37 ], five bronchoscopy [ 11 , 24 , 26 , 38 , 39 ], three cardiology [ 21 , 27 , Scheuermann‐Jahn et al., preprint, https://doi.org/10.21203/rs.3.rs‐989822/v1 ], two dental trials [ 23 , 40 ] and one endovascular trial [ 25 ]. Three of the trials studied children [ 21 , 23 , 26 ], one each in cardiology [ 21 ], bronchoscopy [ 26 ] and dental procedures [ 23 ] with a total sample size of 329 patients.…”

“…Adverse events were not consistently reported across trials. The requirement of upgrade to facemask, tracheal intubation, bag-mask ventilation, positive pressure ventilation and non-invasive ventilation were described in six trials [9,12,25,26,37…”

“…Although these reviews were in favour of HFNO in mitigating the risk of hypoxaemia, there was a paucity of subgroup analyses exploring the influence of covariates and how it may influence the overall interpretation of data. Since then, eight new trials, including three in children, both in favour of [ 21 , 22 , 23 , 24 , 25 , 26 , Scheuermann‐Jahn et al, preprint, https://doi.org/10.21203/rs.3.rs‐989822/v1 ] and against [ 27 ] the application of HFNO have been published, which adds to the body of evidence. A comprehensive review reporting the effect of HFNO across all procedures and age groups using grading of recommendations, assessment, development, and evaluation (GRADE) recommendations is lacking.…”

Respiratory support with nasal high flow without supplemental oxygen in patients undergoing endoscopic retrograde cholangiopancreatography under moderate sedation: a prospective, randomized, single-center clinical trial

“…Deep sedation using another sedative agent, such as dexmedetomidine or anesthetics propofol, is now well accepted in managing ERCP. Vijitpavan et al [23] suggested that the use of NHF cannula in patients undergoing endovascular surgery under deep sedation using propofol reduced desaturation events greater than the use of a traditional nasal cannula. Therefore, further RCTs would be required to con rm the effects of NHF on respiratory management during ERCP under moderate to deep sedation.…”

“…Vijitpavan A et al [23] suggested that the use of NHF in patients undergoing endovascular surgery under deep sedation reduced desaturation events when compared with conventional O 2 via nasal cannula with no difference in the level of PaCO 2 in arterial blood gas analyses (42.48 in conventional nasal canula vs. 44.8 in NHF; p = 0.107). Higuchi H. et al [24] suggested that the PaCO 2 was 50.1 ± 6.0 mmHg in the standard nasal cannula group and 47.6 ± 4.8 mmHg in the NHF group ( ow, 40 L/min, 40% O 2 ).…”