High-Flow Nasal Cannula in Subjects Undergoing Endoscopy With Intravenous Sedation

Area of Science:

• Gastroenterology
• Pulmonology
• Anesthesiology

Background:

• High-flow nasal cannula (HFNC) is a noninvasive oxygenation method delivering heated, humidified oxygen at high flows, potentially aiding airway patency during sedation.
• Its use during procedures like ERCP with deep sedation may improve oxygenation and airway management.
• This study investigates HFNC's efficacy in maintaining oxygen saturation during ERCP.

Purpose of the Study:

• To compare the incidence of oxygen saturation reduction in patients undergoing ERCP with deep sedation using HFNC versus conventional oxygen therapy.
• To evaluate secondary outcomes including lowest oxygen saturation, snoring, and patient/physician satisfaction.

Main Methods:

• A single-center randomized trial involving 60 patients undergoing ERCP under deep intravenous sedation.
• Patients were randomized into three groups: conventional oxygen (5 L/min), HFNC at 15 L/min, or HFNC at 60 L/min, all with an FiO2 of ~0.40.
• Oxygen saturation (SpO2) was monitored at 1-minute intervals throughout the procedures.

Main Results:

• No significant differences were found in the incidence of oxygen saturation falls or the lowest observed SpO2 among the three groups.
• Average SpO2 during ERCP was significantly higher in both HFNC groups (99.2-99.6%) compared to the conventional oxygen group (97.4%).
• Procedure duration, snoring scores, and satisfaction levels did not differ significantly across the groups.

Conclusions:

• In low-risk patients undergoing ERCP, HFNC oxygen therapy at an FiO2 of 0.40 did not decrease the rate or lowest level of oxygen saturation reduction compared to standard low-flow oxygen.
• HFNC therapy, however, resulted in higher average oxygen saturation levels during the procedure.