High-flow Nasal Oxygenation in Infants Undergoing Tracheal Intubation: A Single-center Randomized Controlled Trial

High-flow nasal oxygenation (HFNO) is increasingly used as an alternative for preoxygenation and apneic oxygenation during tracheal intubation. However, its efficacy in infants remains underexplored. This study evaluated whether HFNO improves intubation outcomes compared to those with face mask ventilation in infants.

This prospective, single-center randomized controlled trial included 132 infants undergoing elective surgery under tracheal intubation. The infants were divided into HFNO and control groups, with both groups receiving 100% oxygen. The HFNO group received HFNO for preoxygenation (0.5 l · kg -1 · min -1 for 3 min), as well as during the apneic period (2 l · kg -1 · min -1 for 1 min) and laryngoscopy (2 l · kg -1 · min -1 ). The control group received face mask preoxygenation (6 l/min for 3 min), followed by face mask ventilation during the apneic period (6 l/min for 1 min) and no oxygen delivery during laryngoscopy. The primary outcome was the desaturation incidence (peripheral oxygen saturation of less than 95% for 5 s or longer) from preoxygenation to 1 min after intubation. Various secondary outcomes were also assessed.

After exclusions, 125 infants were analyzed (HFNO: n = 60; control: n = 65). There was no statistically significant between-group difference in the incidence of oxygen saturation less than 95% (control vs . HFNO: 9.2% vs . 13.3%; relative risk, 1.44; 95% CI, 0.53 to 3.92; P = 0.658). With regard to secondary outcomes, the incidence of oxygen saturation less than 90%, first-attempt intubation success rate, lowest oxygen saturation, postintubation end-tidal carbon dioxide and oxygen, and atelectasis scores were similar between groups. Gastric insufflation was less frequent in the HFNO group; the difference was statistically significant (36.7% vs . 70.8%; P < 0.001).

In the current study involving the use of HFNO for preoxygenation and apneic oxygenation during tracheal intubation in infants, there was no significant difference in the incidence of desaturation between HFNO and face mask ventilation, although the former was associated with less frequent gastric insufflation.