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High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial.
Gastrointest Endosc 2019; 90(4):591-601GE

Abstract

BACKGROUND AND AIMS

Hypoxia is one of the most frequent adverse events with sedated GI endoscopy and can lead to serious consequences. No modalities have been found previously to prevent hypoxia. High-flow nasal cannula (HFNC) supportive oxygen therapy provides heated and humidified oxygen up to 60 L/minute. Because of its ability to improve respiratory function and good tolerance, we aimed to evaluate the validity and safety of HFNC supportive oxygen therapy in preventing the incidence of hypoxia in patients undergoing gastroscopy with propofol sedation.

METHODS

In a multicenter, prospective randomized single-blinded study, 1994 outpatients undergoing routine gastroscopy with propofol sedation provided by an anesthesiologist were randomized into 2 groups: the nasal cannula group (O2 [2 L/minute] was supplied via an HFNC) and the HFNC group (O2 [30-60 L/minute] was supplied via an HFNC) at 3 centers from November 2017 to February 2018. The primary outcome was the incidence of hypoxia. Other adverse events were also recorded.

RESULTS

HFNC supportive oxygen therapy decreased the incidence of hypoxia (75% ≤ Spo2 < 90% for <60 seconds) and severe hypoxia (Spo2 < 75% for any duration or 75% ≤ Spo2 < 90% for ≥60 seconds) from 8.4% to 0% (P < .001) and from 0.6% to 0% (P = .03), respectively. The only HFNC-related adverse event was xeromycteria/rhinalgia (1.7%), which was observed 1 minute after the procedure and disappeared after 30 minutes.

CONCLUSIONS

HFNC supportive oxygen therapy can prevent the incidence of hypoxia and severe hypoxia in patients in America Society of Anesthesiologists class I-II undergoing elective gastroscopy under propofol sedation, with minimal related adverse events and good tolerance. (Clinical trial registration number: NCT03332433.).

Authors+Show Affiliations

Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.Department of Anesthesiology, Shanghai Tongji Hospital affiliated to Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200092, China.Department of Anesthesiology, Pudong New Area People's Hospital, 490 South Chuanhuan Road, Shanghai, 201200, China.Department of Anesthesiology, Shanghai Tongji Hospital affiliated to Tongji University School of Medicine, 389 Xincun Road, Shanghai, 200092, China.Department of Anesthesiology, Pudong New Area People's Hospital, 490 South Chuanhuan Road, Shanghai, 201200, China.Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Shanghai, 200127, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31278907

Citation

Lin, Yuxuan, et al. "High-flow Nasal Cannula Oxygen Therapy and Hypoxia During Gastroscopy With Propofol Sedation: a Randomized Multicenter Clinical Trial." Gastrointestinal Endoscopy, vol. 90, no. 4, 2019, pp. 591-601.
Lin Y, Zhang X, Li L, et al. High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial. Gastrointest Endosc. 2019;90(4):591-601.
Lin, Y., Zhang, X., Li, L., Wei, M., Zhao, B., Wang, X., ... Su, D. (2019). High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial. Gastrointestinal Endoscopy, 90(4), pp. 591-601. doi:10.1016/j.gie.2019.06.033.
Lin Y, et al. High-flow Nasal Cannula Oxygen Therapy and Hypoxia During Gastroscopy With Propofol Sedation: a Randomized Multicenter Clinical Trial. Gastrointest Endosc. 2019;90(4):591-601. PubMed PMID: 31278907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial. AU - Lin,Yuxuan, AU - Zhang,Xiaoqing, AU - Li,Lizhi, AU - Wei,Mengyun, AU - Zhao,Bin, AU - Wang,Xiaojing, AU - Pan,Zhiying, AU - Tian,Jie, AU - Yu,Weifeng, AU - Su,Diansan, Y1 - 2019/07/03/ PY - 2019/02/20/received PY - 2019/06/15/accepted PY - 2019/7/7/pubmed PY - 2019/7/7/medline PY - 2019/7/7/entrez SP - 591 EP - 601 JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. VL - 90 IS - 4 N2 - BACKGROUND AND AIMS: Hypoxia is one of the most frequent adverse events with sedated GI endoscopy and can lead to serious consequences. No modalities have been found previously to prevent hypoxia. High-flow nasal cannula (HFNC) supportive oxygen therapy provides heated and humidified oxygen up to 60 L/minute. Because of its ability to improve respiratory function and good tolerance, we aimed to evaluate the validity and safety of HFNC supportive oxygen therapy in preventing the incidence of hypoxia in patients undergoing gastroscopy with propofol sedation. METHODS: In a multicenter, prospective randomized single-blinded study, 1994 outpatients undergoing routine gastroscopy with propofol sedation provided by an anesthesiologist were randomized into 2 groups: the nasal cannula group (O2 [2 L/minute] was supplied via an HFNC) and the HFNC group (O2 [30-60 L/minute] was supplied via an HFNC) at 3 centers from November 2017 to February 2018. The primary outcome was the incidence of hypoxia. Other adverse events were also recorded. RESULTS: HFNC supportive oxygen therapy decreased the incidence of hypoxia (75% ≤ Spo2 < 90% for <60 seconds) and severe hypoxia (Spo2 < 75% for any duration or 75% ≤ Spo2 < 90% for ≥60 seconds) from 8.4% to 0% (P < .001) and from 0.6% to 0% (P = .03), respectively. The only HFNC-related adverse event was xeromycteria/rhinalgia (1.7%), which was observed 1 minute after the procedure and disappeared after 30 minutes. CONCLUSIONS: HFNC supportive oxygen therapy can prevent the incidence of hypoxia and severe hypoxia in patients in America Society of Anesthesiologists class I-II undergoing elective gastroscopy under propofol sedation, with minimal related adverse events and good tolerance. (Clinical trial registration number: NCT03332433.). SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/31278907/High-flow_nasal_cannula_oxygen_therapy_and_hypoxia_during_gastroscopy_with_propofol_sedation:_a_randomized_multicenter_clinical_trial L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(19)32021-8 DB - PRIME DP - Unbound Medicine ER -