The Efficacy of High Flow Nasal Oxygenation for Maintaining Maternal Oxygenation During Rapid Sequence Induction in Pregnancy: A Prospective Randomized Clinical Trial

Zhou, S.; Zhou, Y.; Cao, Xiaoxia; Ni, X.; Du, W.; Xu, Z.; Liu, Z.

doi:10.1097/01.aoa.0000853668.28009.77

Cited by 5 publications

(25 citation statements)

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“…The results of previous studies have been mixed in respect of physiological endpoints of this type [14][15][16][17][18][19][20][21][22][23][24]26]. This probably reflects differences in patient groups, in the technicalities of how HFNO was administered and in how the data were obtained.…”

Section: Discussionmentioning

confidence: 99%

Ease and comfort of pre‐oxygenation with high‐flow nasal oxygen cannulae vs. facemask: a randomised controlled trial

et al. 2022

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The Difficult Airway Society recommends that all patients should be pre-oxygenated before the induction of general anaesthesia, but this may not always be easy or comfortable and anaesthesia may often be induced without full pre-oxygenation. We tested the hypothesis that high-flow nasal oxygen cannulae would be easier and more comfortable than facemasks for pre-oxygenation. We randomly allocated 199 patients undergoing elective surgery aged ≥ 10 years to pre-oxygenation using either high-flow nasal oxygen or facemask. Ease and comfort were assessed by anaesthetists and patients on 10-cm visual analogue scale and six-point smiley face scale, respectively. Secondary endpoints included end-tidal oxygen fraction after securing a definitive airway and time to secure an airway. A mean difference (95%CI) between groups in ratings of -0.76 (-1.25 to -0.27) cm for ease of use (p = 0.003) and -0.45 (-0.75 to -0.13) points for comfort (p = 0.006), both favoured high-flow nasal oxygen. A mean difference (95%CI) between groups in end-tidal oxygen fraction of 3.89% (2.41-5.37%) after securing a definitive airway also favoured high-flow nasal oxygen (p < 0.001). There was no significant difference between groups in the number of patients with hypoxaemia (S p O 2 < 90%) or severe hypoxaemia (S p O 2 < 85%) lasting ≥ 1 min or ≥ 2 min; in the proportion of patients with an end-tidal oxygen fraction < 87% in the first 5 min after tracheal intubation (52.2% vs. 58.9% in facemask and high-flow nasal oxygen groups, respectively; p = 0.31); or in time taken to secure an airway (11.6 vs. 12.2 min in facemask and high-flow nasal oxygen groups, respectively; p = 0.65). In conclusion, we found pre-oxygenation with high-flow nasal oxygen to be easier for anaesthetists and more comfortable for patients than pre-oxygenation with a facemask, with no clinically relevant differences in end-tidal oxygen fraction after securing a definitive airway or time to secure an airway. The differences in ease and comfort were modest.

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Section: Discussionmentioning

confidence: 99%

Ease and comfort of pre‐oxygenation with high‐flow nasal oxygen cannulae vs. facemask: a randomised controlled trial

et al. 2022

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“…1. The systemic review identified a total of 16 randomized controlled trials, [8–23] which enrolled 1148 patients. Patients were divided into the HFNO group (n = 576) and FMO group (n = 572).…”

Section: Resultsmentioning

confidence: 99%

“…Four studies evaluated obese patients for surgery [8,15,16,22] . Two studies recruited healthy pregnant women who required tracheal intubation for elective cesarean section [20,23] …”

Section: Resultsmentioning

confidence: 99%

“…However, it remains uncertain whether HFNO is more efficacious in enhancing arterial oxygenation or reducing peri-intubation desaturation compared with standard facemask oxygenation (FMO). This controversy is potentially due to the study limitations of previous studies, including small sample sizes and discrepancies in oxygenation protocol [8–23] . Recent meta-analyses focused on the efficacy of HFNO in critically ill patients with acute respiratory failure [24,25] .…”

Section: Introductionmentioning

confidence: 99%

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A comparison of high-flow nasal cannula and standard facemask as pre-oxygenation technique for general anesthesia

Kuo

Liu

et al. 2022

Medicine

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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.

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“…Pregnant women may have significant nasal congestion, but HFNC still appears effective. 31 Little data exist to identify appropriate oxygen targets (see below), and many references suggest a higher oxygen level than in the non-pregnant population. There is little evidence to support this, but there is evidence that hyperoxygenation may have adverse maternal hemodynamic effects in pregnancy.…”

Section: Management Of Critical Illness (Figure 1)mentioning

confidence: 99%

COVID-19 critical illness in pregnancy

Lapinsky

Mandhari

2021

Obstet Med

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Although the pregnant population was affected by early waves of the COVID-19 pandemic, increasing transmission and severity due to new viral variants has resulted in an increased incidence of severe illness during pregnancy in many regions. Critical illness and respiratory failure are relatively uncommon occurrences during pregnancy, and there are limited high-quality data to direct management. This paper reviews the current literature on COVID-19 management as it relates to pregnancy, and provides an overview of critical care support in these patients. COVID-19 drug therapy is similar to that used in the non-pregnant patient, including anti-inflammatory therapy with steroids and IL-6 inhibitors, although safety data are limited for antiviral drugs such as remdesivir and monoclonal antibodies. As both pregnancy and COVID-19 are thrombogenic, thromboprophylaxis is essential. Endotracheal intubation is a higher risk during pregnancy, but mechanical ventilation should follow usual principles. ICU management should be directed at optimizing maternal well-being, which in turn will benefit the fetus.

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The Efficacy of High Flow Nasal Oxygenation for Maintaining Maternal Oxygenation During Rapid Sequence Induction in Pregnancy: A Prospective Randomized Clinical Trial

Cited by 5 publications

References 0 publications

Ease and comfort of pre‐oxygenation with high‐flow nasal oxygen cannulae vs. facemask: a randomised controlled trial

Ease and comfort of pre‐oxygenation with high‐flow nasal oxygen cannulae vs. facemask: a randomised controlled trial

A comparison of high-flow nasal cannula and standard facemask as pre-oxygenation technique for general anesthesia

COVID-19 critical illness in pregnancy

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