BackgroundIn recent years, high flow nasal oxygen(HFNO) has been widely used in clinic, especially in perioperative period.Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial.Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis ofRCTs.MethodsEMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevantrandomized controlled trails(RCTs) on the effectiveness of HFNO versus standard facemask ventilation(FMV) inpre- and apenic oxygenation. Studies involving one of the following six indicators: (1)Arterial oxygen partialpressure(PaO2), (2)End expiratory oxygen concentration(EtO2), (3)Safe apnoea time, (4)Minimum pulse oxygensaturation(SpO2min), (5)Oxygenation(O2) desaturation, (6)End expiratory carbon dioxide(EtCO2) or Arterial carbondioxide partial pressure(PaCO2) were included. We select random effect model or fixed effect model for analysisaccording to the heterogeneity of the article, and express it as the mean difference(MD) or risk ratio(RR) with aconfidence interval of 95%(95%CI). We conducted a risk assessment of bias for eligible studies and assessed theoverall quality of evidence for each outcome.Results14 RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMVgroup with a MD(95% CI) of 57.38 mmHg(25.65 to 89.10; p=0.0004) after preoxygenation and the safe apnoeatime was significantly longer with a MD(95% CI) of 86.93 seconds(44.35 to 129.51; p<0.0001) during anesthesiainduction. There were no significant statistical difference in the minimum O2 saturation, CO2 accumulation, endexpiratory oxygen concentration and O2 desaturation rate during anesthesia induction between the two groups.ConclusionsThis systematic review and meta-analysis suggests that HFNO should be considered as an airway managementtool for patients with high-risk hypoxemia or difficult airway during anesthesia induction. Compared with FMV,continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safeapnoea time in surgical patients.
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