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

2021 ◽  
Author(s):  
Man-Jong Lee ◽  
Boram Cha ◽  
Jin-Seok Park ◽  
Jung Soo Kim ◽  
Sang Yong Cho ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Elderly Patients ◽  
Randomized Clinical Trial ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
High Flow ◽  
Nasal Cannula ◽  
High Flow Nasal Cannula ◽  
Endoscopic Retrograde

scholarly journals High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

2020 ◽  
Author(s):  
Venkatesan Thiruvenkatarajan ◽  
Ashok Dharmalingam ◽  
Gilberto Arenas ◽  
Medhat Wahba ◽  
Reinhard Steiner ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Perioperative Complications ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
High Flow Nasal Cannula ◽  
Endoscopic Retrograde ◽  
Study Results

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly common intervention in the treatment of pancreatico-biliary disorders. Patients are often elderly with complex co-morbidities. While monitored anaesthesia care with sedation is commonly used for most cases, few would require general anaesthesia with an endotracheal tube. Both low flow and high flow nasal cannulas (HFNC) are established ways of delivering supplemental oxygen, but it is unclear whether one technique is better than the other. HFNC seems a promising tool for advanced procedures but evidence to support its application in high-risk ERCP cases is limited. The rate of oxygen desaturation during endoscopy has been reported to be as high as 11-50%, and the method of oxygen delivery for ERCP merits further study. Methods/design This is a prospective, randomised, multi-centre trial comparing the efficacy of oxygen supplementation through high flow nasal cannula versus low flow nasal cannula during ERCP, in a cohort of patients at risk of adverse respiratory events. A total of 132 patients will be recruited across three sites and randomly assigned to either the low flow or the HFNC group. The primary outcome is the proportion of patients experiencing hypoxia, defined by any event of SpO2 <90%. The secondary outcomes include parameters centred on oxygenation, requirement of airway manoeuvres, successful completion of procedure, perioperative complications, patient satisfaction, and cost analysis of the consumables. An intention-to-treat principle will be applied while analysing. Discussion The demand for ERCPs is likely to increase in the future with the aging population. Our study results may lead to improved outcomes and reduce airway related complications in patients undergoing ERCPs. The results will be presented at national and international meetings and published in per-reviewed journals.

scholarly journals High-flow nasal cannula versus standard oxygen therapy assisting sedation during endoscopic retrograde cholangiopancreatography in high risk cases (OTHER): study protocol of a randomised multicentric trial

2020 ◽  
Author(s):  
Venkatesan Thiruvenkatarajan ◽  
Ashok Dharmalingam ◽  
Gilberto Arenas ◽  
Medhat Wahba ◽  
Reinhard Steiner ◽  
...  
Keyword(s):  
High Risk ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Perioperative Complications ◽  
Supplemental Oxygen ◽  
High Flow ◽  
Nasal Cannula ◽  
Low Flow ◽  
High Flow Nasal Cannula ◽  
Endoscopic Retrograde ◽  
Study Results

Abstract Background Endoscopic retrograde cholangiopancreatography (ERCP) is an increasingly common intervention in the treatment of pancreatico-biliary disorders. Patients are often elderly with complex co-morbidities. While monitored anaesthesia care with sedation is commonly used for most cases, few would require general anaesthesia with an endotracheal tube. Both low flow and high flow nasal cannulas (HFNC) are established ways of delivering supplemental oxygen, but it is unclear whether one technique is better than the other. HFNC seems a promising tool for advanced procedures but evidence to support its application in high-risk ERCP cases is limited. The rate of oxygen desaturation during endoscopy has been reported to be as high as 11-50%, and the method of oxygen delivery for ERCP merits further study.Methods/design This is a prospective, randomised, multi-centre trial comparing the efficacy of oxygen supplementation through high flow nasal cannula versus low flow nasal cannula during ERCP, in a cohort of patients at risk of adverse respiratory events. A total of 132 patients will be recruited across three sites and randomly assigned to either the low flow or the HFNC group. The primary outcome is the proportion of patients experiencing hypoxia, defined by any event of SpO2 <90%. The secondary outcomes include parameters centred on oxygenation, requirement of airway manoeuvres, successful completion of procedure, perioperative complications, patient satisfaction, and cost analysis of the consumables. An intention-to-treat principle will be applied while analysing.Discussion The demand for ERCPs is likely to increase in the future with the aging population. Our study results may lead to improved outcomes and reduce airway related complications in patients undergoing ERCPs. The results will be presented at national and international meetings and published in per-reviewed journals.Trial registration: www.ANZCTR.org.au CTRN12619000397112, Registered on on March 12, 2019.

scholarly journals Effect of post-extubation high-flow nasal cannula on reintubation in elderly patients: a retrospective propensity score-matched cohort study

2020 ◽  
Vol 14 ◽  
pp. 175346662096849
Author(s):  
Ryoung-Eun Ko ◽  
Chul Park ◽  
Jimyoung Nam ◽  
Myeong Gyun Ko ◽  
Soo Jin Na ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Propensity Score ◽  
Elderly Patients ◽  
Oxygen Therapy ◽  
High Flow ◽  
Nasal Cannula ◽  
Control Group ◽  
High Flow Nasal Cannula ◽  
Mechanically Ventilated ◽  
Clinical Benefits

Background: Studies of mechanically ventilated patients with a low risk of reintubation have suggested that the use of high-flow nasal cannula (HFNC) oxygen therapy reduces the risk of reintubation compared with conventional oxygen therapy (COT). However, the effect of HFNC following extubation in elderly patients with a high risk of reintubation remains unclear. Methods: All consecutive medical intensive care unit (ICU) patients aged >65 years who were mechanically ventilated for >24 h were prospectively registered between July 2017 and June 2018. Control was obtained from a historical database of patients attending the same ICU from January 2012 to December 2013. A total of 152 patients who underwent HFNC after planned extubation according to institutional protocols (HFNC group) were compared with a propensity-matched historical control group who underwent COT ( n = 175, COT group). The primary outcome was the proportion of reintubated patients within 48 h after planned extubation. Results: One hundred patients from the HFNC group and 129 patients from the COT group were matched by a propensity score that reflected the probability of receiving HFNC, and all variables were well matched. Post-extubation respiratory failure (41.0% versus 33.3%, p = 0.291) and reintubation rate within 48 h (16.0% versus 11.6%, p = 0.436) did not differ between the HFNC and COT groups. However, decreased levels of consciousness as a sign of post-extubation respiratory failure (27.0% versus 11.7%, p = 0.007) were significantly increased in the HFNC group compared with the COT group. Conclusion: Among elderly patients who underwent planned extubation, HFNC was not associated with a decrease in the risk of reintubation. Further prospective study evaluating the clinical benefits of post-extubation HFNC in elderly patients is needed. The reviews of this paper are available via the supplemental material section.

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