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A randomised controlled trial comparing high‐flow nasal oxygen with standard management for conscious sedation during bronchoscopy
Author(s) -
Douglas N.,
Ng I.,
Nazeem F.,
Lee K.,
Mezzavia P.,
Krieser R.,
Steinfort D.,
Irving L.,
Segal R.
Publication year - 2018
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.14156
Subject(s) - medicine , anesthesia , sedation , oxygenation , nasal cannula , oxygen saturation , randomized controlled trial , oxygen therapy , oxygen , surgery , chemistry , organic chemistry , cannula
Summary Traditional conscious sedation for endobronchial ultrasound procedures places patients at risk of desaturation, and high‐flow nasal oxygen may reduce the risk. We designed a parallel‐group randomised controlled trial of high‐flow nasal oxygen at a flow rate of 30–70 l.min −1 via nasal cannulae, compared with standard oxygen therapy at 10 l.min −1 via a bite block in adults planned for conscious sedation for endobronchial ultrasound. The primary outcome was the proportion of patients experiencing desaturation (defined as SpO 2 < 90%). Secondary outcomes included oxygen saturation after pre‐oxygenation, lowest oxygen saturation during procedure, number of hypoxic episodes, duration of hypoxia, end‐procedure end‐tidal CO 2 , satisfaction scores and complications. Thirty participants were allocated to each group. Baseline patient characteristics, procedure time and anaesthetic agents used were similar between the groups. Desaturation occurred in 4 out of 30 patients allocated to the high‐flow nasal oxygen group, compared with 10 out of 30 allocated to the standard oxygenation group, a non‐significant difference (p = 0.07) with intention to treat analysis. The difference was significant (p = 0.047) when using a per‐protocol analysis. Oxygen saturation after pre‐oxygenation and the lowest oxygen saturation during procedure were significantly higher in the high‐flow nasal oxygen group compared with the standard oxygenation group; median ( IQR [range] 100 (99–100 [93–100]) vs. 98 (97–99 [94–100]), p = 0.0001 and 97.5 (94–99 [77–100]) vs. 92 (88–95 [79–98]), p < 0.001, respectively. There were no differences in other secondary outcomes. Although high‐flow nasal oxygen may prevent desaturation due to some causes, it does not protect against hypoxaemia in all circumstances.