Is High Flow Nasal Oxygenation a Game Changer in Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

Objectives: A pilot observational study was done to compare High Flow Nasal Oxygen (HFNO) and supraglottic airway device (SAD) technique in patients undergoing endobronchial ultrasound (EBUS) and transbronchial needle aspiration procedures (TBNA) with an objective to evaluate the efficacy of HFNO  in oncological patients. Methods:  The study was conducted in a tertiary cancer center in Muscat, Sultanate of Oman from May 2022 to March 2023.  Consecutive patients undergoing EBUS TBNA under moderate sedation were quasi-randomized into HFNO and SAD groups. The episodes and duration of hypoxia and the lowest level of oxygen saturation were the primary outcome measured. Results: A total of twenty-four patients were taken into the study of which 10 were in the HFNO group and 14 were in the SAD group with an equal number of males and females.  The duration of the procedure in both the groups was similar (45±20 mins in HFNO vs 44±17 in the SAD group). Mean lowest oxygen saturation in the HFNO group was (93.5%±4), which was statistically significant in comparison to the SAD group (90±6). In both groups, the maximum hypoxia occurred during the early phase of the procedure. However, both the groups were similar for the cumulative duration of hypotension (140 secs in HFNO vs 55 secs in SAD) and bradycardia (25 secs in HFNO vs. 40 secs in SAD). Conclusion: HFNO can be a good alternative to the SAD and could be used safely and efficiently in the cohort of population in patients undergoing EBUS TBNA. Keywords: High flow nasal oxygenation; Endobronchial Ultrasound-guided Transbronchial Needle Aspiration; Supraglottic airway devices.