High-flow nasal cannula versus standard low-flow nasal cannula during deep sedation in patients undergoing radiofrequency atrial fibrillation catheter ablation: a single-centre randomised controlled trial

Abstract

Background To our knowledge, there are few trials studying the effect of high-flow nasal cannula (HFNC) during deep sedation. Our hypothesis is that high-flow nasal cannula (HFNC) will prevent hypoxemia and desaturation as compared to low-flow nasal cannula (LFNC) during prolonged deep sedation in patients with atrial fibrillation undergoing radiofrequency catheter ablation (RFCA). Methods A single-centre, randomised controlled trial with HFNC as the intervention and LFNC as the control group. A total of 94 adult patients per group undergoing elective radiofrequency atrial fibrillation catheter ablation under deep sedation. will be included. The primary outcome is the lowest oxygen saturation (SpO2). Secondary outcomes are as follows: the duration of lowest SpO2, cross over from oxygen therapy in both directions, incidence of SpO2 below 90% > 60 seconds, adverse sedation events, adverse effects of HFNC, mean CO2, peak CO2 and patients experience with oxygen therapy. The study will take place during the 2-day admission period for RFCA. Patients can fill out their questionnaires in the first week after treatment. Discussion HFNC is increasingly used as a technique for oxygen delivery in procedural sedation and analgesia. We hypothesise that HFNC is superior to the standard treatment LFNC in patients under deep sedation with respect to the incidence of desaturation. To our knowledge, there are no adequately powered clinical trial studies on the effects of HFNC in prolonged deep sedation. Trial registration ClinicalTrials.gov NCT04842253. Registered on 04 April 2021

Comparison of high flow nasal cannula oxygen therapy versus nasal cannula in sedated transesophageal echocardiography in patients with mitral regurgitation: a prospective, randomized controlled clinical trial

“…It has been shown in multiple studies that HFNC can improve patient oxygenation and comfort after gastrointestinal endoscopy, respiratory tract infections, and extubation. Nevertheless, few studies have been conducted on patients at high risk of cardiogenic hypoxia [14,21].…”

“…A growing number of patients receiving procedural sedation and analgesia rely on oxygen delivered via HFNC [10]. To validate HFNC in various procedural sedations, randomized controlled trials have been carried out, including gastrointestinal endoscopy, bronchoscopy, endoscopic retrograde cholangiopancreatography, and atrial brillation catheter ablation [11][12][13][14]. Currently, there is no study comparing the use of HFNC and nasal cannula during sedated TEE.…”

Place of high-flow nasal oxygen in nonoperating room anesthesia

“…While there was no significant difference in arterial oxygenation between HFNO (with FiO 2 30%) and SOT (2 l/min), the HFNO group exhibited a lower incidence of hypoxemia ( P = 0.027), and patients reported a higher comfort score ( P ≤ 0.001) [30]. An ongoing single center RCT is assessing the use of HFNO in radiofrequency atrial fibrillation catheter ablation [31].…”

Effect of inspiratory muscle training on hypoxemia in obese patients undergoing painless gastroscopy: protocol for a single-center, double-blind, randomized controlled trial

“…It is important to acknowledge that these approaches mainly target the upper airway rather than the smaller airways, leading to limited tolerance during the recovery phase and potentially unsuitability for high-risk hypoxemia patients. While the efficacy and safety of highflow nasal cannula (HFNC) as a promising alternative for improving oxygenation in obese individuals have been established (2,(12)(13)(14), the practical implementation of HFNC in less developed regions remains unfeasible due to the requirement for specialized equipment, trained personnel, and the associated high costs (9). Therefore, it is crucial to identify an effective, practical, and non-invasive method to improve hypoxemia during painless gastroscopy for obese patients.…”