High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial.

Yu-Tzu Wang,Chien‐Kun Ting,Chun-Li Lin,Huihua Chiang,Ming-Chih Hou,Wen-Kuei Chang,Wei-Nung Teng,Mei-Yung Tsou

doi:10.1155/2019/4206795

Abstract

During sedated endoscopic examinations, upper airway obstruction occurs. Nasal breathing often shifts to oral breathing during open mouth esophagogastroduodenoscopy (EGD). High-flow nasal cannula (HFNC) which delivers humidified 100% oxygen at 30 L min−1 may prevent hypoxemia. A mandibular advancement (MA) bite block with oxygen inlet directed to both mouth and nose may prevent airway obstruction during sedated EGD. The purpose of this study was to evaluate the efficacy of these airway devices versus standard management. One hundred and eighty-nine patients were assessed for eligibility. One hundred and fifty-three were enrolled. This study randomly assigned eligible patients to three arms: the standard bite block and standard nasal cannula, HFNC, and MA bite block groups. EGD was performed after anaesthetic induction. The primary endpoint was the oxygen desaturation area under curve at 90% (AUCDesat). The secondary endpoints were percentage of patients with hypoxic, upper airway obstruction, and apnoeic and rescue events. One hundred and fifty-three patients were enrolled. AUCdesat was significantly lower for HFNC and MA bite blocks versus the standard management (p= 0.019). The HFNC reduced hypoxic events by 18% despite similar airway obstruction and apnoeic events as standard group. The MA bite block reduced hypoxic events by 12% and airway obstructions by 32%. The HFNC and MA groups both showed a 16% and 14% reduction in the number of patients who received rescue intervention, respectively, compared to the standard group. The HFNC and MA bite block may both reduce degree and duration of hypoxemia. HFNC may decrease hypoxemic events while maintaining nasal patency is crucial during sedative EGD. The MA bite block may prevent airway obstruction and decrease the need for rescue intervention.

Highlights

The safety of sedation during esophagogastroduodenostomy (EGD) has long been a concern [1,2,3]
This study aimed to evaluate the role of High-flow nasal cannula (HFNC) and mandibular advancement (MA) bite block during sedative EGD
One hundred and eighty-nine patients were assessed for eligibility from May 3rd to June 22nd, 2017

Summary

Introduction

The safety of sedation during esophagogastroduodenostomy (EGD) has long been a concern [1,2,3]. Airway management is crucial during deep sedation, since desaturation is noted in up to 60% of patients [8] and as high as 95% of patients have different degrees of airway obstruction [9]. The laryngeal muscle loses tone, causing partial or complete upper airway obstruction [10]. Trained personnel manage the airway by chin-lift, jaw thrust, insertion of nasal airway, or bag-mask ventilation [12]. Serious complications such as cardiopulmonary distress, hypotension, bradycardia, or the need for intubation may occur if the airway is not properly treated [13]

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