Abstract
BackgroundProcedural sedation reduces patients’ discomfort and anxiety, facilitating performance of the examination and intervention. However, it may also cause adverse events, including airway obstruction and hypoxia. We conducted this systematic review and meta-analysis to evaluate the efficacy of high-flow nasal oxygenation (HFNO) compared with that of standard oxygen therapy in adult patients undergoing procedural sedation.MethodsWe identified randomized controlled trials published before November 2020 based on PubMed, Embase, and Cochrane Library databases and ClinicalTrials.gov registry. Intraprocedural desaturation [peripheral oxygen saturation (SpO2) < 90%] was evaluated as the primary outcome. The secondary outcomes were the lowest SpO2, need for airway intervention, oxygen therapy-related complications, and patient, operator, and anesthetist’s satisfaction.ResultsSix trials with a total of 2633 patients were reviewed. Patients using HFNO compared with standard oxygen therapy had a significantly lower risk of intraprocedural desaturation [risk ratio 0.18, 95% confidence interval (CI) 0.04-0.87]. The lowest intraprocedural SpO2 in HFNO group was significantly higher than that in standard oxygen therapy group (mean difference 4.19%, 95% CI 1.74-6.65).ConclusionsCompared with standard oxygen therapy, HFNO may reduce the risk of desaturation and increase the lowest SpO2 in adult patients undergoing sedation for medical procedures.
Highlights
Procedural sedation reduces patients’ discomfort and anxiety, facilitating performance of the examination and intervention
The intraprocedural lowest Peripheral oxygen saturation (SpO2) of high-flow nasal oxygenation (HFNO) group was significantly higher than that of standard oxygen therapy group (WMD, 4.19%, 95% confidence interval (CI), 1.74-6.65) (Fig. 3)
Subgroup analysis revealed that HFNO was linked to a lower risk of airway intervention compared to standard oxygen therapy in nonobese patients (RR, 0.09, 95% CI, 0.02-0.36)
Summary
Procedural sedation reduces patients’ discomfort and anxiety, facilitating performance of the examination and intervention. It may cause adverse events, including airway obstruction and hypoxia. Pain, and discomfort, such as gastrointestinal endoscopy, bronchoscopy, and dental treatment. These procedures are frequently performed with sedation to reduce patients’ discomfort and apprehension, contributing to a better quality of examination or intervention (Meining et al 2007). Sedation itself may decrease respiratory drive, cause upper airway obstruction, and thereafter hypoxia during procedures (Mason et al 2019; Amornyotin 2013). It is crucial to prevent the occurrence of hypoxia while providing an adequate depth of sedation
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