High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in prolonged upper GI endoscopy: a...

Supplemental oxygen during upper GI (UGI) endoscopy is considered standard practice, but the optimal modality of oxygen delivery on a prolonged UGI endoscopy procedure is unclear. Given the paucity of data on the impact of a prolonged procedure, we aimed to evaluate the use of high-flow nasal cannula (HFNC) oxygen therapy versus conventional oxygen therapy (COT) in patients undergoing prolonged (>20 minutes) UGI endoscopy.

A prospective randomized controlled trial was conducted at an Australian tertiary hospital. Patients undergoing UGI endoscopy expected to take over 20 minutes were randomized to receive either HFNC oxygen therapy (Optiflow system [Fisher and Paykel Healthcare Ltd, Auckland, New Zealand] at 60 L/min) or COT (standard nasal cannula at 2 L/min). The primary outcome was the incidence of moderate hypoxemia (saturation of peripheral oxygen [SpO₂] < 90%) of any duration.

Ninety-six patients were included in the intention-to-treat analysis. The incidence of hypoxemia (SpO₂ < 90%) was significantly reduced in the HFNC cohort, with no patients experiencing hypoxemia, compared with 20% in the COT cohort (P < .002). Fifty-one percent in the COT cohort had an episode of SpO₂ ≤ 94% compared with 5% in the HFNC cohort. Thirty-six percent of patients in the COT arm had clinically significant hypoxemia requiring intervention, with no patients in the HFNC arm requiring intervention (P < .001). No difference was observed in patient-, sedation-, or procedure-related adverse events.

The use of HFNC oxygen therapy significantly reduced the incidence of hypoxemia among our cohort of patients undergoing prolonged UGI endoscopic procedures. (Clinical trial registration number: ACTRN12620000931976.).