Trends in Anaesthesia and Critical Care最新文献

{"title":"Comparison of three different flow rates of oxygen with high-flow nasal cannula versus conventional nasal oxygen therapy in adult patients undergoing endoscopic retrograde cholangiopancreatography","authors":"Arundhati Chadha ,&nbsp;Anil Yogendra Yadav ,&nbsp;Udit Dhingra ,&nbsp;Gaurav Sindwani ,&nbsp;Vinod Arora ,&nbsp;Deepak K. Tempe","doi":"10.1016/j.tacc.2025.101600","DOIUrl":"10.1016/j.tacc.2025.101600","url":null,"abstract":"<div><h3>Background</h3><div>Endoscopic retrograde cholangiopancreatography is commonly performed under monitored anaesthesia care for diagnosis and treatment of biliary and pancreatic disorders. The procedure involves prone or semi-prone positioning, which increases the risk of oxygen desaturation during sedation. Conventional nasal oxygen therapy provides only low flow delivery and is often insufficient to maintain oxygenation. High flow nasal cannula oxygenation has emerged as a promising alternative, capable of delivering heated and humidified oxygen at higher flow rates, generating low levels of positive airway pressure, and facilitating carbon dioxide clearance. However, the most effective flow rate to prevent oxygen desaturation for high flow nasal cannula oxygenation during this procedure remains uncertain.</div></div><div><h3>Methods</h3><div>A prospective randomized controlled trial was conducted in a tertiary care hospital between August and October 2024. A total of 102 adult patients, aged 18–70 years, with American Society of Anaesthesiologists physical status grades I to III, scheduled for endoscopic retrograde cholangiopancreatography under sedation, were enrolled. Patients were randomized to receive either conventional nasal oxygen at 6 L per minute (n = 51) or high flow nasal cannula oxygenation (n = 51). The high flow nasal cannula group was further subdivided into three equal subgroups receiving flow rates of 30, 40, or 50 L per minute, each with a fraction of inspired oxygen fixed at 0.4. The primary outcome was the incidence of hypoxia, defined as peripheral oxygen saturation less than 92 percent lasting for at least 10 s. Secondary outcomes included severity of hypoxia, need for airway interventions, hemodynamic changes, adverse events, and patient satisfaction.</div></div><div><h3>Results</h3><div>The incidence of hypoxia was significantly lower in the high flow nasal cannula group (17.6 percent) compared to the conventional nasal oxygen group (35.3 percent, p = 0.042). The median lowest peripheral oxygen saturation was also higher in the high flow group (96 percent) compared to the conventional group (93 percent, p = 0.023). Among the high flow subgroups, the 50 L per minute group demonstrated the best outcomes, with the lowest incidence of hypoxia (11.8 percent) and the highest median lowest peripheral oxygen saturation (98 percent). Mild and moderate hypoxia were significantly reduced with high flow therapy, whereas severe hypoxia was rare and not different between groups. Adverse events were infrequent, with dryness of the airway slightly more common in the conventional group. Hemodynamic parameters and patient satisfaction were comparable across groups.</div></div><div><h3>Conclusion</h3><div>High flow nasal cannula oxygenation is more effective than conventional nasal oxygen in preventing hypoxia during endoscopic retrograde cholangiopancreatography under sedation. A flow rate of 50 L per minute with a fraction of ins","PeriodicalId":44534,"journal":{"name":"Trends in Anaesthesia and Critical Care","volume":"65 ","pages":"Article 101600"},"PeriodicalIF":0.7,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145466153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}