Preoxygenation with high-flow nasal oxygen versus conventional techniques using anatomical face mask in patients...

Preoxygenation is crucial during rapid sequence induction, especially in peritonitis patients undergoing exploratory laparotomy who are prone to hypoxaemia. This study compares high-flow nasal oxygen (HFNO) versus facemask for preoxygenation efficacy, laryngoscopy duration, desaturation, arterial blood gases, and patient comfort.

Sixty consenting, haemodynamically stable patients aged ≥15 years, scheduled for exploratory laparotomy, were randomised into two equal groups receiving preoxygenation using either HFNO at 50 L/min for 5 min or standard anatomical facemask (SMO) at 10 L/min. Arterial blood gas samples were obtained preoperatively, 5 min after preoxygenation, and 1 min following intubation. The primary outcome was partial pressure of arterial oxygen (PaO₂) after 5 min of preoxygenation. Secondary outcomes included partial pressure of arterial carbon dioxide (PaCO₂), peripheral oxygen saturation (SpO₂), laryngoscopy duration, desaturation incidence, patient comfort, and haemodynamic parameters. Statistical analysis was performed using independent t-test, Wilcoxon test, and Chi-square test. P <0.05 was considered statistically significant.

PaO₂ 5 min after preoxygenation was higher in both groups, the mean (standard deviation) increase, greater in HFNO [376.86 (86.57)] than in SMO group [263.68 (77.39)]. This rise was higher even 1 min after intubation in HFNO group [312.89 (82.87)] versus SMO [215.61 (66.95)]. HFNO group also showed a less incidence of desaturation and a decrease in PaCO₂ [31.73 (5.46)] than in SMO group [35.72 (8.11)].

Preoxygenation for 5 min by HFNO is superior to facemask as there is an increase in PaO₂, decreased PaCO₂, less desaturation, and more comfort to patients undergoing exploratory laparotomy.