Use of optiflow THRIVE high-flow nasal oxygen system versus a non-rebreather oxygen delivery device in patients with increased risk of airway obstruction in interventional radiology procedures: a randomized pilot study.

内容摘要

The configuration of interventional radiology (IR) suites often limits simultaneous access to the patient's airway and anesthesia equipment. This constraint may lead to suboptimal sedation in patients at increased risk of airway obstruction due to patient safety concerns. We conducted a randomized pilot trial to evaluate whether high-flow nasal oxygen (HFNO; F&P Optiflow™) reduces hypoxic events compared with a standard non-rebreather mask in this high-risk population undergoing deep sedation. Patients at increased risk of airway obstruction or hypoxia during deep sedation were randomized to receive 100% oxygen via HFNO at 70 L/min (HFNO group) or via non-rebreather mask at 8 L/min (standard-of-care [SoC] group). All patients received continuous intravenous propofol to achieve unconsciousness while maintaining spontaneous ventilation. The primary endpoint was total length of desaturation episodes [ToLDE], in minutes, defined as oxygen saturation [SpO2] ≤92%. Secondary outcomes included the number of desaturation episodes, bispectral index (BIS) excursions (defined as episodes of BIS value ≥ 61), postanesthesia care unit (PACU) length of stay, and patient-reported symptoms. A total of 101 patients were analyzed (HFNO group: n = 50; SoC group: n = 51). Mean ToLDE time was 0.34 min (median, 0; range 0-6.5 min) in the HFNO group and 0.97 min (median, 0; range 0-19.8 min) in the SoC group (P = 0.158). Desaturation occurred in 14% of HFNO patients vs. 26% of SoC patients (P = 0.212). The median number of BIS excursions was significantly higher in the SoC group (4; range, 0-19) than the HFNO group (2; range, 0-15; P = 0.005). Median PACU stay was shorter in the HFNO group (20 min; range, 0-60) vs. in the SOC group (26 min; range, 5-60) (P = 0.076). Patient-reported symptoms were less frequent and less severe in the HFNO group (12% vs. 16%). HFNO did not significantly reduce hypoxic events compared with a standard non-rebreather oxygen delivery device in patients at increased risk of airway obstruction during deep intravenous sedation. However, HFNO was associated with improved sedation stability and patient experience, supporting further investigation in larger studies. ClinicalTrials.gov ID: NCT04171037; Date of original registration: November 19, 2019; This study was retrospectively registered. Study principal investigator: Gang Zheng; This manuscript adheres to the applicable Consolidated Standards of Reporting Trials (CONSORT) guidelines.