Impact of High-Flow Nasal Cannula Oxygenation on the Prevention of Hypoxia During Endoscopic Retrograde Cholangiopancreatography in Elderly Patients: A Randomized Clinical Trial

Sedation strategy for retrograde cholangiopancreatography in older patients

“…2 Even using high-flow nasal cannula oxygenation with a flow rate of 50 L/min and an intake oxygen fraction of 50% during ERCP with propofol deep sedation in older patients, Lee et al reported that the incidence of hypoxemia was 4%. 3 In contrast, only one patient with chronic obstructive pulmonary disease developed hypoxemia in this study. Besides oxygen 2 L/min being administered through a nasal cannula, the authors did not clearly describe whether airway maneuvers, such as jaw thrust and oropharyngeal or nasopharyngeal airway, were also used during ERCP with deep sedation.…”

Methodological Insight to the High-Flow Nasal Cannula Oxygenation in Elderly Undergoing Endoscopic Retrograde Cholangiopancreatography

“…Lee and colleague’s study is intriguing to analyze the benefits of high flow nasal cannula (HFNC) oxygenation in the endoscopic retrograde cholangiopancreatography (ERCP) procedure in elderly patients [ 1 ]. We applaud the work as the study contributes towards a significant advancement in the control of oxygenation during ERCP and opens new possibilities.…”

“…We thank Dr. Habib Md Reazaul Karim for giving the consideration and opportunity to discuss to our study [ 1 ]. Our randomized trial suggested that high flow nasal cannula (HFNC) oxygenation in the endoscopic retrograde cholangiopancreatography (ERCP) under sedation can maintain oxygen saturation and prevent unexpected hypoxia events [ 1 ]. The protective effect of HFNC originated mainly from several physiologic factors, including continuous positive airway pressure and warm humidification.…”

“…Thus, respiratory drive and transpulmonary pressure gradient may be reduced in prone position, which probably improves oxygenation. In addition, prone position with deep sedation during endoscopic procedure did not affect maintenance of oxygen saturation and end tidal carbon dioxide level [ 1 , 9 ]. Therefore, prone and lateral position during ERCP can be feasible to prevent desaturation.…”

Should We Use High-Flow Nasal Cannula in Patients Receiving Gastrointestinal Endoscopies? Critical Appraisals through Updated Meta-Analyses with Multiple Methodologies and Depiction of Certainty of Evidence

“…Several randomized controlled trials (RCTs) [11][12][13][14][15][16][17][18] had studied the use of HFNC in patients who received GI endoscopies during sedation. However, the study designs were heterogeneous, and study results were inconsistent.…”