Prophylactic Postoperative High Flow Nasal Oxygen Versus Conventional Oxygen Therapy in Obese Patients Undergoing Bariatric Surgery (OXYBAR Study): a Pilot Randomised Controlled Trial
“…The proportion of patients with obstructive sleep apnea (OSA) was between 12.5 and 72.5% in five trials 23 – 27 , while five studies did not provide this information 28 – 32 . Of the ten studies, two assessed the beneficial effects of HFNO on postoperative pulmonary parameters in patients receiving laparoscopic bariatric surgery 23 , 24 , while eight studies evaluated the efficacy of HFNO against peri-procedural hypoxemia or oxygenation status during anesthesia induction (six trials) 26 – 30 , 32 , tracheal intubation in the intensive care unit (one trial) 31 , and colonoscopy under deep sedation (one trial) 25 . In the HFNO groups, the flow rate ranged from 50 to 120 L/min.…”
Section: Resultsmentioning
confidence: 99%
“…In the HFNO groups, the flow rate ranged from 50 to 120 L/min. In the control groups receiving COT/NIV, mask oxygenation was adopted in four studies 23 , 24 , 27 , 29 , while NIV and nasal cannula oxygenation were used in other four 26 , 30 – 32 and two 25 , 28 RCTs, respectively. Figure 1 PRISMA flow diagram of study selection for the current meta-analysis.…”
Section: Resultsmentioning
confidence: 99%
“…Two RCTs provided information on postprocedural respiratory parameters at three hours 23 , 24 . This time point was chosen based on the observation that patients undergoing bariatric surgery usually spend three hours in the postanesthesia care unit before discharge 23 .…”
This meta-analysis aimed at investigating the efficacy of high-flow nasal oxygenation (HFNO) against hypoxemia in patients with obesity compared with conventional oxygenation therapy and non-invasive ventilation. Databases were searched from inception to August 2021. Studies involving peri- or post-procedural use of HFNO were included. The primary outcome was risk of hypoxemia, while the secondary outcomes included status of oxygenation and carbon dioxide elimination. Ten randomized controlled trials (RCTs) were included. We found that HFNO prolonged the safe apnea time at induction compared to control group [mean difference (MD) = 73.88 s, p = 0.0004; 2 RCTs] with no difference in risk of peri-procedural hypoxemia [relative risk (RR) = 0.91, p = 0.64; 4 RCTs], minimum SpO2 (MD = 0.09%, p = 0.95; 4 RCTs), PaO2 (MD = − 8.13 mmHg, p = 0.86; 3 RCTs), PaCO2 (MD = − 6.71%, p = 0.2; 2 RCTs), EtCO2 (MD = − 0.28 mmHg, p = 0.8; 4 RCTs) between the two groups. HFNO also did not improve postprocedural PaO2/FiO2 ratio (MD = 41.76, p = 0.58; 2 RCTs) and PaCO2 (MD = − 2.68 mmHg, p = 0.07; 2 RCTs). This meta-analysis demonstrated that the use of HFNO may be associated with a longer safe apnea time without beneficial impact on the risk of hypoxemia, oxygenation, and CO2 elimination in patients with obesity. The limited number of trials warranted further large-scale studies to support our findings.
“…The proportion of patients with obstructive sleep apnea (OSA) was between 12.5 and 72.5% in five trials 23 – 27 , while five studies did not provide this information 28 – 32 . Of the ten studies, two assessed the beneficial effects of HFNO on postoperative pulmonary parameters in patients receiving laparoscopic bariatric surgery 23 , 24 , while eight studies evaluated the efficacy of HFNO against peri-procedural hypoxemia or oxygenation status during anesthesia induction (six trials) 26 – 30 , 32 , tracheal intubation in the intensive care unit (one trial) 31 , and colonoscopy under deep sedation (one trial) 25 . In the HFNO groups, the flow rate ranged from 50 to 120 L/min.…”
Section: Resultsmentioning
confidence: 99%
“…In the HFNO groups, the flow rate ranged from 50 to 120 L/min. In the control groups receiving COT/NIV, mask oxygenation was adopted in four studies 23 , 24 , 27 , 29 , while NIV and nasal cannula oxygenation were used in other four 26 , 30 – 32 and two 25 , 28 RCTs, respectively. Figure 1 PRISMA flow diagram of study selection for the current meta-analysis.…”
Section: Resultsmentioning
confidence: 99%
“…Two RCTs provided information on postprocedural respiratory parameters at three hours 23 , 24 . This time point was chosen based on the observation that patients undergoing bariatric surgery usually spend three hours in the postanesthesia care unit before discharge 23 .…”
This meta-analysis aimed at investigating the efficacy of high-flow nasal oxygenation (HFNO) against hypoxemia in patients with obesity compared with conventional oxygenation therapy and non-invasive ventilation. Databases were searched from inception to August 2021. Studies involving peri- or post-procedural use of HFNO were included. The primary outcome was risk of hypoxemia, while the secondary outcomes included status of oxygenation and carbon dioxide elimination. Ten randomized controlled trials (RCTs) were included. We found that HFNO prolonged the safe apnea time at induction compared to control group [mean difference (MD) = 73.88 s, p = 0.0004; 2 RCTs] with no difference in risk of peri-procedural hypoxemia [relative risk (RR) = 0.91, p = 0.64; 4 RCTs], minimum SpO2 (MD = 0.09%, p = 0.95; 4 RCTs), PaO2 (MD = − 8.13 mmHg, p = 0.86; 3 RCTs), PaCO2 (MD = − 6.71%, p = 0.2; 2 RCTs), EtCO2 (MD = − 0.28 mmHg, p = 0.8; 4 RCTs) between the two groups. HFNO also did not improve postprocedural PaO2/FiO2 ratio (MD = 41.76, p = 0.58; 2 RCTs) and PaCO2 (MD = − 2.68 mmHg, p = 0.07; 2 RCTs). This meta-analysis demonstrated that the use of HFNO may be associated with a longer safe apnea time without beneficial impact on the risk of hypoxemia, oxygenation, and CO2 elimination in patients with obesity. The limited number of trials warranted further large-scale studies to support our findings.
“…The use of HFNO after tracheal extubation was demonstrated to prevent hypoxemia among obese patients following bariatric surgery in one study [ 40 ] but not another. [ 41 ] In propofol sedation for colonoscopy, the desaturation rate was similar between HFNO and standard nasal cannula. [ 42 ] These disagreements may come from the discrepancies in the oxygenation protocol and study outcomes.…”
Section: Discussionmentioning
confidence: 99%
“…The greater risk of oxygen desaturation in obese patients warrants further development of pre-oxygenation techniques for anesthesia care. However, it remains inconclusive whether HFNO is superior to FMO in preventing perioperative desaturation in obese patients [8,15,16,22,40–42] . Heinrich et al [8] reported that HFNO for 3 minutes generated the highest PaO 2 compared with oxygen insufflation or continuous positive airway pressure via a facemask.…”
Background: Current practice guidelines recommend the use of nasal cannula as an alternative pre-oxygenation method for tracheal intubation. However, the efficacy of high-flow nasal oxygenation versus standard facemask oxygenation has not been fully evaluated.Methods: We searched PubMed, Cochrane Library, and ClinicalTrials.gov for English-language studies published from January 1, 2000 to November 30, 2021. We included randomized controlled trials which compared high-flow nasal oxygenation and facemask oxygenation as the pre-oxygenation maneuver. Primary outcome was arterial partial pressure of oxygen (PaO 2 ) after preoxygenation. Secondary outcomes were safe apnea time, arterial desaturation during intubation, lowest peripheral capillary oxygen saturation during intubation, and patient comfort score. Random-effects models and Mantel-Haenszel method were used for data synthesis.Results: A total of 16 randomized controlled trials and 1148 patients were included. High-flow nasal oxygenation achieved a higher PaO 2 compared with facemask, mean difference: 64.86 mm Hg (95% confidence interval [CI]: 32.33-97.40, P < .0001). Safe apnea time was longer in high-flow nasal oxygenation, mean difference: 131.03 seconds (95% CI: 59.39-202.66, P < .0001). There was no difference in the risk of peri-intubation desaturation or lowest peripheral capillary oxygen saturation between groups. Patient comfort score was higher in high-flow nasal oxygenation, mean difference: 1.00 (95% CI: 0.46-1.54, P = .0003).Conclusion: High-flow nasal oxygenation better enhanced PaO 2 and extended safe apnea time and is not inferior to facemask oxygenation in preventing desaturation during tracheal intubation. High-flow nasal oxygenation may be considered as an alternative method, especially for patients with a potential difficult airway.Abbreviations: CI = confidence interval, FMO = facemask oxygenation, GA = general anesthesia, HFNO = high-flow nasal oxygenation, PaO 2 = arterial partial pressure of oxygen, PEEP = positive end-expiratory pressure, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-analyses, RR = risk ratio, SpO 2 = peripheral capillary oxygen saturation.
Background and Aim: Postoperative hypoxemia is common after general anesthesia in obese patients. We investigated if early application of high-flow nasal oxygen (HFNO) improved postoperative oxygenation in obese patients compared with standard oxygen therapy following general anesthesia for laparoscopic bariatric surgery.
Methods:This was an open labeled randomized controlled trial conducted at a
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