Effectiveness of High-Flow Nasal Oxygen vs. Standard Nasal Oxygen in Preventing Hypoxia During Procedural Sedation in...

Background and Objectives: Hypoxia is the most common adverse event in patients undergoing procedural sedation. Burn-related pain is severe and often requires high doses of opioids and anxiolytics, increasing the risk of respiratory depression. This study aimed to compare the effectiveness of high-flow nasal oxygen (HFNO) and standard nasal oxygen (SNO) in preventing hypoxia during deep sedation in patients with minor and moderate burns. Materials and Methods: This single-center prospective observational study enrolled 76 adult patients (ASA I-III) with minor to moderate burns undergoing supine-position procedures under sedation. Patients were allocated to HFNO (n = 38) or SNO (n = 38) groups according to a pre-specified, non-randomized allocation rule based on an alternating/sequential assignment by admission order. Peripheral oxygen saturation (SpO₂), Bispectral Index (BIS), and Near-Infrared Spectroscopy (NIRS) were monitored throughout. Desaturation was defined as SpO₂ ≤ 90%; severe hypoxia as SpO₂ < 75%. Sedation depth was standardized using BIS (target: 60-80). Propofol-ketamine-based induction was used in all patients. Results: Groups were comparable in demographics, comorbidities, burn characteristics, and procedural duration. SpO₂ ≤ 90% occurred in 79% of SNO patients vs. 11% in the HFNO group (p < 0.001). SpO₂ between 75 and 90% was observed in 68% of SNO vs. 0% of HFNO patients (p < 0.001), and SpO₂ < 75% in 26% vs. 0% (p < 0.001). Airway interventions-jaw thrust, flow increase, and FiO₂ increase-were significantly more frequent in the SNO group (84% vs. 2.6%, 84% vs. 11%, and 84% vs. 5.3%, respectively; all p < 0.001). No significant between-group differences were noted in procedure interruptions, laryngospasm, BIS, NIRS, or hemodynamic parameters. Conclusions: HFNO significantly reduced the incidence of hypoxia and the need for airway interventions compared with SNO during deep sedation in minor and moderate burn patients. These findings suggest that HFNO may represent a preferable oxygenation strategy in this population; given the observational design of this study, confirmation in randomized controlled trials is warranted before this can inform routine practice recommendations.