Effects of high-flow nasal oxygen during prolonged deep sedation on postprocedural atelectasis

Shih, Chung-Chih; Liang, Po-Chin; Chuang, Yueh-Hsun; Huang, Yi-Ju; Lin, Pei-Jing; Wu, Chun-Yu

doi:10.1097/eja.0000000000001324

Cited by 9 publications

(8 citation statements)

References 25 publications

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“…The feasibility of HFNO for NIBTS is also consistent with the results of bronchoscopy research ( 21 - 23 ) and with a shorter length of PACU stay. HFNO may have the advantage of causing minimal stress during airway management and preventing atelectasis ( 24 ). However, randomized controlled studies should be performed in the future.…”

Section: Discussionmentioning

confidence: 99%

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes

Fang,

Lin,

Yao

et al. 2024

J Thorac Dis

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Background Anesthesia remains challenging for bronchoscopic tracheobronchial surgeries (BTS) involving surgical manipulations for central airway obstruction within shared airways. To provide complete airway use through intervention with spontaneous breathing without endotracheal tubes, monitored non-intubated anesthesia has been successfully applied with electroencephalogram-derived monitored total intravenous anesthesia. This study evaluated the feasibility and the outcomes of BTS with monitored non-intubated anesthesia. The factors associated with desaturation and complications were also analyzed. Methods Data from patients receiving non-intubated BTS performed between October 2019 and August 2022 were retrospectively collected. Intraoperative results and postoperative outcomes were analyzed. Results Data of 92 patients were collected. Supraglottic airways devices and high-flow nasal oxygen were used in 68 and 24 patients respectively. Surgery was successfully completed in 87 patients (94.6%), whereas three patients required conversion to intubation because of substantial bleeding. In total, 11% of patients experienced desaturation [oxygen saturation (SpO 2 ) <90%] for an average of 9 minutes. Unexpected admission to the intensive care unit (ICU) occurred in 12.2% (5/41) of patients from outpatient department and 7.8% (4/51) of hospitalization settings because of high-grade surgical bleeding. With comparable desaturation incidence, tracheal surgery had significantly longer desaturation times (14.5±6.9 min) than bronchial surgeries (5.8±2.6 min) did. Conclusions Monitored non-intubated anesthesia with spontaneous breathing is feasible for BTS, with high success rate, few complications, and rapid recovery. High-grade bleeding remains the most unpredictable risk for intraoperative desaturation and postoperative ICU admission, especially in tracheal obstruction cases.

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Section: Discussionmentioning

confidence: 99%

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes

Fang,

Lin,

Yao

et al. 2024

J Thorac Dis

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“…High concentrations of oxygen replace the nitrogen in the alveoli, leading to atelectasis [30,31]. Another study demonstrated that HFNCO reduces the occurrence of atelectasis during postoperative long-range deep sedation compared with a mask [32]. Because of the characteristics of hypoxic pulmonary vasoconstriction in pulmonary blood vessels, shunts may increase near alveoli with low oxygen concentrations, which further aggravates the imbalance of the ventilation/blood flow ratio.…”

Section: Discussionmentioning

confidence: 99%

Application of high-flow nasal cannula oxygenation in the induction of general anesthesia by direct providers: A case series

Liu

Meng

Chen

et al. 2022

Preprint

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Background: Pressurized mask-assisted ventilation is commonly used during general anesthesia, which often requires the cooperation of two anesthesiologists and creates a severe shortage of anesthesiologists. High-flow nasal cannula oxygenation (HFNCO) is reportedly effective in perioperative airway management, but its safety and efficacy in the induction of general anesthesia by direct providers have not been confirmed. Methods: Twelve patients were enrolled in our study. Their vital signs were recorded before surgery (T0), and HFNCO was continuously applied after admission. Blood gas analysis results were recorded before pre-oxygenation (T1), during anesthetic induction (T2), and before mechanical ventilation (T3). Results: The mean arterial partial pressure of oxygen (PaO2) was 86.6±26.0, 245.3±90.6, and 170.0±99.4 mmHg at T1, T2, and T3, respectively, and the lowest pulse oxygen saturation (SpO2) was 92% at T3. The mean arterial partial pressure of carbon dioxide (PaCO2) was 39.0±6.2, 40.0±5.7, and 50.2±8.7 mmHg, respectively; the highest was 71.1 mmHg. The mean pH was 7.40±0.02, 7.39±0.05, and 7.35±0.06, respectively. One patient switched to pressurized mask-assisted ventilation because of severe hypoxemia (lowest SpO2, 82%) during apnea oxygenation. Conclusions: HFNCO significantly improves oxygenation levels without severe hypercapnia and can be safely applied to general anesthesia induction by direct providers.

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“…These results were also observed across subgroups, including variations in the type of procedures, the FiO 2 , the hypoxemic profile of the patients, and the mode of propofol administration [35 && ]. Additional indications, such as computed tomography-guided hepatic tumor radiofrequency ablation [36], awake craniotomy [37], and hysteroscopy for assisted reproduction [38], also demonstrated favorable outcomes with the use of HFNO.…”

Section: Key Pointsmentioning

confidence: 99%

Place of high-flow nasal oxygen in nonoperating room anesthesia

Nay,

Auvet

2024

Current Opinion in Anaesthesiology

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Purpose of review This article aims to assess the utility of high-flow nasal oxygen (HFNO) therapy in nonoperating room anesthesia (NORA) settings. Recent findings The number of procedural interventions under deep sedation in NORA is still increasing. Administration of oxygen is recommended to prevent hypoxemia and is usually delivered with standard oxygen through nasal cannula or a face mask. HFNO is a simple alternative with a high warmed humidified flow (ranging from 30 to 70 l/min) with a precise fraction inspired of oxygen (ranging from 21 to 100%). Compared to standard oxygen, HFNO has demonstrated efficacy in reducing the incidence of hypoxemia and the need for airway maneuvers. Research on HFNO has primarily focused on its application in gastrointestinal endoscopy procedures. Yet, it has also shown promising results in various other procedural interventions including bronchoscopy, cardiology, and endovascular procedures. However, the adoption of HFNO prompted considerations regarding cost-effectiveness and environmental impact. Summary HFNO emerges as a compelling alternative to conventional oxygen delivery methods for preventing hypoxemia during procedural interventions in NORA. However, its utilization should be reserved for patients at moderate-to-high risk to mitigate the impact of cost and environmental factors.

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Effects of high-flow nasal oxygen during prolonged deep sedation on postprocedural atelectasis

Cited by 9 publications

References 25 publications

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes

Non-intubated bronchoscopic tracheobronchial surgeries with electroencephalogram-monitored intravenous anesthesia: feasibility and outcomes

Application of high-flow nasal cannula oxygenation in the induction of general anesthesia by direct providers: A case series

Place of high-flow nasal oxygen in nonoperating room anesthesia

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