Related Experiment Video
Updated: Feb 2, 2026
Author Spotlight: Advancements and Challenges in Surgical Treatments for Postamputation Pain
Published on: March 8, 2024
High-flow nasal oxygen versus face-mask ventilation for rapid sequence induction in non-elective surgical patients: a
Nguyen Duc Lam1,2, Le Dinh Thanh Son3, Tran Minh Phat3
1Department of Anesthesiology and Resuscitation, Hanoi Medical University, No. 01, Ton That Tung Street, Kim Lien Ward, Hanoi, 11520, Vietnam.
Background:
Patients undergoing non-elective surgery frequently require rapid sequence induction (RSI) because of concerns related to recent oral intake, impaired gastric emptying, or uncertain fasting status. Previous randomized controlled trials have reported mixed results regarding the effectiveness of high-flow nasal cannula (HFNC) in preventing oxygen desaturation during RSI. This study evaluated the effect of HFNC compared with facemask ventilation (FMV) during RSI in a non-elective surgical population.
Methods:
In this randomized controlled study, adult ASA I-II patients undergoing non-elective surgery were allocated to HFNC (100% O₂, 60 L·min⁻1) or FMV (FiO₂ 1.0, 10 L·min⁻1) during RSI. A modified RSI protocol was applied, including predefined induction agents, cricoid pressure, gentle facemask ventilation as needed, and cuffed tracheal intubation. The primary outcome was peri-intubation oxygenation. Secondary outcomes included CO₂ accumulation, hemodynamic variables, gastric volume, patient comfort, and adverse events. Trial registration was performed retrospectively.
Results:
Among 214 analyzed patients (107 per group), no desaturation events (SpO₂ < 94%) occurred in the HFNC group versus 12.1% in FMV (p < 0.001). HFNC yielded higher PaO₂ after preoxygenation (445.7 ± 16.8 vs. 314.2 ± 14.5 mmHg) and after intubation (405.5 ± 17.7 vs. 236.5 ± 58.5 mmHg; both p < 0.001). End-tidal oxygen concentrations were also higher with HFNC (86.0 ± 11.4% vs. 75.7 ± 12.3%; p < 0.001). CO₂ accumulation, hemodynamic variables, gastric volume, and aspiration incidence were similar between groups. Mild nasal dryness reduced comfort with HFNC, and one patient withdrew because of discomfort; overall tolerance remained acceptable.
Conclusion:
HFNC appeared to improve oxygenation compared with FMV in this low-risk, non-elective surgical cohort. Within the limits of this physiologically stable population, HFNC was well tolerated and did not increase measured gastric or hemodynamic complications.
Trial Registration:
ClinicalTrials, NCT06879600. Retrospectively registered on 05 March 2025, https://clinicaltrials.gov/study/NCT06879600 .
Related Concept Videos
01:26Oxygen Delivering System I: Nasal Cannula and Face Mask
Nasal Cannula
A nasal cannula is a lightweight tube split at one end into two prongs and placed in the nostrils. It is typically used to deliver low to medium levels of oxygen.
Suggested flow rate: The suggested flow rate for a nasal cannula typically ranges between 1 and 6 L/min.
Oxygen percentage setting:...
01:30Administering Oxygen by Mask
Administering oxygen by mask is a common nursing intervention that provides supplemental oxygen to patients with respiratory distress or chronic lung conditions. This procedure involves delivering oxygen at a specified rate through a face mask connected to an oxygen source.
Equipment
The equipment necessary for this procedure includes:
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:29Administering Oxygen by Nasal Cannula
Nasal Cannulas
A nasal cannula is a lightweight tube split into two prongs placed in the nostrils,...
01:24Rapidly Varying Flow
01:30Control of Power Flow