Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective, Randomized Trial

Duan, Xuefei; Wei, Ning; Wei, Jinfeng; Zhu, Yi; Kang, Y. James; He, Yi; Huang, Jiapeng; Wang, Sheng

doi:10.1053/j.jvca.2021.03.031

Cited by 10 publications

(35 citation statements)

References 28 publications

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“…21203/rs.3.rs-989822/v1], two dental trials [23,40] and one endovascular trial [25]. Three of the trials studied children [21,23,26], one each in cardiology [21], bronchoscopy [26] and dental procedures [23] with a total sample size of 329 patients. Four trials assessed patients at high risk of developing hypoxaemia [9,22,35,37] in one [38] and a combination of low-flow nasal oxygen and bite block oxygen insufflation in one [37].…”

Section: Resultsmentioning

confidence: 99%

Effect of high‐flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta‐analysis

et al. 2022

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Summary We conducted a systematic review to evaluate the effect of high‐flow nasal oxygen and conventional oxygen therapy during procedural sedation amongst adults and children. We searched MEDLINE, EMBASE and CINAHL for randomised controlled trials that reported the effects of high‐flow nasal oxygen during procedural sedation. The primary outcome measure was hypoxaemia and the secondary outcomes were minimum oxygen saturation; hypercarbia; requirement for airway manoeuvres; and procedure interruptions. The quality of evidence was assessed using the revised Cochrane risk‐of bias tool and grading of recommendations, assessment, development and evaluation (GRADE). Nineteen randomised controlled trials (4121 patients) including three in children were included. Administration of high‐flow nasal oxygen reduced hypoxaemia, risk ratio (95%CI) 0.37 (0.24–0.56), p < 0.001; minor airway manoeuvre requirements, risk ratio (95%CI) 0.26 (0.11–0.59), p < 0.001; procedural interruptions, risk ratio (95%CI) 0.17 (0.05–0.53), p = 0.002; and increased minimum oxygen saturation, mean difference (95%CI) 4.1 (2.70–5.50), p < 0.001; as compared with the control group. High‐flow nasal oxygen had no impact on hypercarbia, risk ratio (95%CI) 1.24 (0.97–1.58), p = 0.09, I2 = 0%. High‐flow nasal oxygen reduced the incidence of hypoxaemia regardless of the procedure involved, degree of fractional inspired oxygen, risk‐profile of patients and mode of propofol administration. The evidence was ascertained as moderate for all outcomes except for procedure interruptions. In summary, high‐flow nasal oxygen compared with conventional oxygenation techniques reduced the risk of hypoxaemia, increased minimum oxygen saturation and reduced the requirement for airway manoeuvres. High‐flow nasal oxygen should be considered in patients at risk of hypoxaemia during procedural sedation.

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Section: Resultsmentioning

confidence: 99%

Effect of high‐flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta‐analysis

et al. 2022

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“…Similarly, in spontaneously breathing children (not apneic oxygenation!) under deep sedation no gastric insufflation was found with the use of HFNO [18]. Also, a study in spontaneously breathing adults with HFNO did not find gastric distension or an increase in gastric secretions [19].…”

Section: Reviewmentioning

confidence: 92%

“…Duan et al [18] reported that the use of HFNO for deep sedation in the congenital cardiac catheter lab reduced the incidence of desaturations and the need for assisted ventilation compared to simple oxygen mask. Similarly, Sago et al [38] reported that HFNO during dental surgery reduced desaturations and upper airway obstruction in children.…”

Section: Applications Of Hfno Beyond Apneic Oxygenationmentioning

confidence: 99%

Apneic oxygenation in pediatric anesthesia

Kleine‐Brueggeney

Grosshauser

Greif

2022

Current Opinion in Anaesthesiology

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Purpose of reviewApneic oxygenation is increasingly used in pediatric anesthesia. Its benefit for specific applications depends on the effect of apneic oxygenation on safe apnea time and carbon dioxide (CO2) elimination, on differences between low and high flow oxygen delivery, and on possible adverse effects. The present review summarizes current evidence on these pathophysiological aspects of apneic oxygenation as well as its applications in pediatric anesthesia.Recent findingsApneic oxygenation with both low flow and high flow nasal oxygen increases the safe apnea time, but does not lead to increased CO2 elimination. Airway pressures and adverse effects like atelectasis formation, oxidative stress and aerosol generation under apneic oxygenation are not well studied in pediatric anesthesia. Data from adults suggest no important effect on airway pressures when the mouth is open, and no significant formation of atelectasis, oxidative stress or aerosol generation with high flow nasal oxygen.SummaryApneic oxygenation in pediatric anesthesia is mainly used during standard and difficult airway management. It is sometimes used for airway interventions, but CO2 accumulation remains a major limiting factor in this setting. Reports highlight the use of high flow nasal oxygen in spontaneously breathing rather than in apneic children for airway interventions.

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“…This mechanism may be of particular interest for respiratory support in patients with delicate hemodynamic balance, in whom a high could exerts deleterious effects. In a randomized controlled trial (RCT) in pediatric patients with congenital heart disease undergoing procedural sedation, the use of HFNC compared with COT, reduced the incidence of desaturation, the need for NIV and the risk of CO 2 retention without causing hemodynamic instability (62). A case report on a 10-years old patient with Fontan circulation showed that in comparison to COT, HFNC reduced heart rate, systemic vascular resistance, pulmonary vascular resistance, increased cardiac output and improved cerebral circulation, measured by near-infrared spectroscopy (63).…”

Section: Respiratory Support In Case Of Congenital Heart Diseasesmentioning

confidence: 99%

High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children

et al. 2022

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High-flow nasal cannula (HFNC) oxygen therapy has rapidly become a popular modality of respiratory support in pediatric care. This is undoubtedly due to its ease of use and safety, which allows it to be used in a wide variety of settings, ranging from pediatric intensive care to patients' homes. HFNC devices make it possible to regulate gas flow and temperature, as well as allowing some nebulized drugs to be administered, features very useful in children, in which the balance between therapeutic effectiveness and adherence to treatment is pivotal. Although the physiological effects of HFNC are still under investigation, their mechanisms of action include delivery of fixed concentration of oxygen, generation of positive end-expiratory pressure, reduction of the work of breathing and clearance of the nasopharyngeal dead space, while providing optimal gas conditioning. Nevertheless, current evidence supports the use of HFNC mainly in moderate-to-severe bronchiolitis, whereas for asthma exacerbations and breath sleeping disorders there is a lack of randomized controlled trials comparing HFNC to continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV), which are essentials for the identification of response and non-response predictors. In this regard, the development of clinical guidelines for HFNC, including flow settings, indications, and contraindications is urgently needed.

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Effect of High-Flow Nasal Cannula Oxygen Therapy on Pediatric Patients With Congenital Heart Disease in Procedural Sedation: A Prospective, Randomized Trial

Cited by 10 publications

References 28 publications

Effect of high‐flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta‐analysis

Effect of high‐flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta‐analysis

Apneic oxygenation in pediatric anesthesia

High-Flow Nasal Cannula Oxygen Therapy: Physiological Mechanisms and Clinical Applications in Children

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