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Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography.

ABSTRACT: Endoscopic retrograde cholangiopancreatography (ERCP) identifies and treats pancreatic and biliary diseases. We conducted a systematic review and meta-analysis examining relevant papers in five databases to examine the frequency of hypoxia throughout the surgery and the lowest oxygen saturation level in patients under sedation. Our meta-analysis included three randomized controlled trials with 390 participants, 196 in the high-flow oxygen (HFNC) group and 194 in the low-flow oxygen (LFNC) group. Their ages ranged from 65.3 to 79 years. The pooled effect estimate showed that HFNC decreased the incidence of hypoxia during the procedure when compared to LFNC (odds ratio -0.84; 95% confidence interval [CI] -1.65, -0.02; P = 0.04), and the mean of lowest oxygen saturation in patients during sedation was significantly lower in LFNC compared to HFNC (mean difference 2.34; 95% CI 1.35, 3.32; P = 0.001). The pooled effect estimate showed that the HFNC group had a lower incidence rate of jaw thrusting adverse events during anesthesia than the LFNC group (risk difference -0.12; 95% CI -0.21, -0.04; P = 0.001). In summary, HFNC systems reduced the incidence of hypoxia for patients undergoing ERCP and had a higher mean lowest oxygen saturation during sedation.

SUBMITTER: Gamal M

PROVIDER: S-EPMC9196677 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Background Hypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO2) < 90% during bronchoscopy. Methods In this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. Results Eight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO2 < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO2 during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083–0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002–1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group. Conclusions A modified HFNC could decrease the proportion of patients with a single moment of SpO2 < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01744-8.

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Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography.

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