Nasal Cannula Group Research Articles

Laryngeal mask airway or high flow nasal cannulaversusnasal cannula for advanced bronchoscopy – a randomized controlled trial

Research QuestionAdvanced bronchoscopic procedures became a widely prevalent evaluation and treatment modality. These procedures require appropriate sedation and respiratory support. This study directly compares three respiratory support methods during advanced bronchoscopy.MethodsThis 3-arm, prospective, block randomized trial included 60 consenting adult patients that were referred for advanced bronchoscopy involving endobronchial ultrasound with transbronchial needle aspiration (EBUS – TBNA) and met inclusion / exclusion criteria. Patients were randomized to undergo a bronchoscopy through a laryngeal mask airway (LMA), or with a high-flow nasal cannula (HFNC) or low flow nasal cannula (NC), with bronchoscopy performed through a bite block. Demographic, procedural and clinical parameters were compared between the 3 groups, including complications, oxygenation, ventilation and need for intervention.ResultsAnalysis according to intention to treat was made for the 20 patients in each arm. There were no significant differences in demographic parameters, pre-morbidities, and procedure type and duration between groups. Hypoxia was significantly more common in the NC group (90%) compared with the LMA (45%) and HFNC (26%) groups (p<0.01). Need for interventions and their number was also lower in the LMA (40%) and HFNC (52.6%) groups compared to the NC group (90%, p< 0.01). A multivariate analysis confirmed both HFNC and LMA as independent predictors of lower rate of recurrent desaturation events and fewer complications in general compared to NC.

Extended CPAP or low-flow nasal cannula for intermittent hypoxaemia in preterm infants: a 24-hour randomised clinical trial

ObjectiveOptimal timing of continuous positive airway pressure (CPAP) cessation in preterm infants remains undetermined. We hypothesised that CPAP extension compared with weaning to low-flow nasal cannula (NC) reduces intermittent hypoxaemia...

The comparison of preoxygenation methods before endotracheal intubation: a network meta-analysis of randomized trials.

Preoxygenation before endotracheal intubation (ETI) maintains asphyxiated oxygenation and reduces the risk of hypoxia-induced adverse events. Previous studies have compared various preoxygenation methods. However, network meta-analyses (NMAs) of the combined comparison of preoxygenation methods is still lacking. We searched for studies published in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Review Manager version 5.3 was used to evaluate the risk of bias. The primary outcome of this meta-analysis was low oxygen saturation (SpO2) during ETI. The secondary outcomes included SpO2 <80%, SpO2 <90%, and apnea time during ETI. NMA was performed using R 4.1.2 software gemtc packages in RStudio. A total of 15 randomized controlled trials were included in this study. Regarding the lowest SpO2, the noninvasive ventilation (NIV) with high-flow nasal cannula (HFNC) group performed better than the other groups. For SpO2 <80%, the NIV group (0.8603467) performed better than the HFNC (0.1373533) and conventional oxygen therapy (COT, 0.0023) groups, according to the surface under the cumulative ranking curve results. For SpO2 <90%, the NIV group (0.60932667) performed better than the HFNC (0.37888667) and COT (0.01178667) groups. With regard to apnea time, the HFNC group was superior to the COT group (mean difference: -50.05; 95% confidence interval: -90.01, -10.09; P = 0.01). Network analysis revealed that NIV for preoxygenation achieved higher SpO2 levels than HFNC and COT and offered a more significant advantage in maintaining patient oxygenation during ETI. Patients experienced a longer apnea time after HFNC preoxygenation. The combination of NIV with HFNC proved to be significantly superior to other methods. Given the scarcity of such studies, further research is needed to evaluate its effectiveness. identifier CRD42022346013.

Comparison of the effects of high-flow nasal cannula and bilevel positive airway pressure treatments as respiratory physiotherapy interventions for children with asthma exacerbation: a randomized clinical trial.

A high-flow nasal cannula is a practical and safe instrument that can be used for children with asthma exacerbation and promotes beneficial outcomes such as improved asthma severity scores and reduced hospitalization durations, salbutamol use, and oxygen use. To evaluate and compare the efficacy of high-flow nasal cannula treatment and that of bilevel positive airway pressure treatment as respiratory physiotherapy interventions for pediatric patients who are hospitalized because of asthma exacerbation. During a randomized clinical trial, treatment was performed using a high-flow nasal cannula and bilevel positive airway pressure for hospitalized children with asthma. After randomization, data regarding lung function, vital signs, and severity scores (pulmonary index, pediatric asthma severity, and pediatric asthma scores) were collected. Fifty patients were included in this study (25 in the Bilevel Group and 25 in the high-flow nasal cannula group). After 45 minutes of therapy, an improvement in the forced expiratory volume in 1 second was observed. The high-flow nasal cannula group required fewer days of oxygen (O2) use, used fewer bronchodilators (number of salbutamol puffs), and required shorter hospitalization periods than the Bilevel Group (6.1±1.9 versus 4.3±1.3 days; 95% confidence interval, -5.0 to -0.6). A high-flow nasal cannula is a viable option for the treatment of asthma exacerbation because it can reduce the hospitalization period and the need for O2 and bronchodilators. Additionally, it is a safe and comfortable treatment modality that is as effective as bilevel positive airway pressure.ClinicalTrials.gov Identifier: NCT04033666.

Bilevel positive airway pressure ventilation in patients susceptible to hypoxemia during procedural sedation for colonoscopy: a prospective randomized controlled study

Background and aimsHypoxemia is one of the most common adverse events during colonoscopy, particularly among patients who are diagnosed with obstructive sleep apnea (OSA) or are overweight. Consequently, the objective of this study is to evaluate the effectiveness of bilevel positive airway pressure (BPAP) ventilation for patients with high risk hypoxemia during colonoscopy with sedation. MethodsIn this trial, 127 patients who met the eligibility criteria were randomly assigned to the BPAP oxygen and nasal cannula (NC) group. The primary endpoint was the incidence of hypoxemia. ResultsCompared to the use of NC, BPAP ventilation exhibited a significant reduction in the incidence of hypoxemia, decreasing it from 23.8% to 6.3% (absolute risk difference [ARD]: 17.5% [95% confidence interval (CI), 5.4 to 29.6], p = 0.006). Importantly, BPAP ventilation prevented the occurrence of severe hypoxemia (9.5% vs. 0%, ARD: 9.5% [95% CI, 2.3 to 16.7], p = 0.035). Besides, the BPAP group required fewer airway interventions (p < 0.05). ConclusionsIn individuals with OSA or overweight status, the use of BPAP ventilation during colonoscopy significantly reduced the incidence of hypoxemia.

Comparison of the Effectiveness of Nasal Cannula Versus Face Mask With Reservoir Bag in Postoperative Patients Undergoing General Anesthesia: A Prospective Randomized Controlled Trial.

High-concentration oxygen delivery via a face mask (FM) with a reservoir bag is a common practice to prevent postoperative hypoxemia; however, it may also lead to atelectasis and other respiratory complications. Lower concentrations delivered via nasal cannula (NC) may be equally effective in preventing postoperative hypoxemia. The present study aimed to compare peripheral oxygen saturation (SpO_2) delivered via NC versus FM with a reservoir bag in patients who have undergone general anesthesia (GA). Eighty-four patients scheduled for GA were randomized to receive either oxygen via NC (NC group, n = 42) or FM with a reservoir bag (FM group, n = 42) for 30 minutes after GA at a postanesthesia care unit (PACU). All patients were assessed based on SpO_2 value, adverse events, and patient satisfaction (measured using a 100-mm visual analog scale). The overall difference between groups in the change of SpO_2 over 30 minutes at the PACU was -0.004 (95% confidence interval, -0.015 to 0.008; P = 0.527). SpO_2 during the first five minutes was lower in NC group, but the difference was not statistically significant. No desaturation occurred in either group, and there was no observed difference between groups in terms of adverse events. Patient satisfaction scores were also similar (P = 0.612). Oxygen supplementation via NC and via FM with a reservoir bag were equally effective in preventing postoperative hypoxemia after GA.

Efficacy of nasal continuous positive airway pressure as a preferred airway management during intravenous sedation of patients undergoing transcatheter aortic valve replacement

Background As the incidence of aortic stenosis is increasing in correlation with the aging population, symptomatic patients commonly require valve replacement procedures. If left untreated, symptomatic aortic stenosis can lead to death in 2 to 3 years. Often, transcatheter aortic valve replacement (TAVR) procedures are performed with the assistance of oxygenation via nasal cannula. However, oxygenation achieved through a nasal continuous positive airway pressure (nCPAP) device could be a more optimized strategy for patients without any sacrifice in efficacy compared to nasal cannula. Methods A retrospective chart review was conducted on 28 patients at Baylor University Medical Center who presented to the operating room for a TAVR between January and October 2021. Fourteen patients received oxygenation via nasal cannula (control group) and 14 received oxygenation with nCPAP. Information gathered included method of oxygenation, length of stay, episodes of hypoxia (defined as sustained oxygen saturation <92% for at least 1 minute), paravalvular leak, pacemaker placement, and mean atrial valve (AV) gradient before and after the procedure. Results In the nCPAP group, the average length of stay was 2.79 days vs 2.71 days in the nasal cannula group. In the nCPAP group, no patient required a permanent pacemaker, while the nasal cannula group had a 40% rate of permanent pacemaker placement. The average preprocedure AV gradient was 51.14 in the nCPAP group and 42.57 in the nasal cannula group. The average postprocedure AV gradient was 8.5 in the nCPAP group and 5.36 in the nasal cannula group. Both groups had an intensive care unit admission rate of 0%. The rate of paravalvular leak was 35.7% in the nCPAP group and 28.6% in the nasal cannula group. The nCPAP group had an average of 0 episodes of hypoxia and the nasal cannula group had an average of 0.93 episodes of hypoxia. Conclusion The findings demonstrate the viability of nCPAP as an effective method of oxygenation during intravenous sedation of TAVR patients when compared to oxygenation achieved via nasal cannula during TAVRs.

Nasopharyngeal SARS-CoV-2 may not be dispersed by a high-flow nasal cannula

A high-flow nasal cannula (HFNC) therapy plays a significant role in providing respiratory support to critically ill patients with coronavirus disease 2019 (COVID-19); however, the dispersion of the virus owing to aerosol generation is a matter of concern. This study aimed to evaluate if HFNC disperses the virus into the air. Among patients with COVID-19 admitted to private rooms with controlled negative pressure, we enrolled those admitted within 10 days of onset and requiring oxygenation through a conventional nasal cannula or HFNC therapy. Of the 17 patients enrolled, we obtained 22 samples (11 in the conventional nasal cannula group and 11 in the HFNC group). Viral RNA was detected in 20 nasopharyngeal swabs, and viable viruses were isolated from three nasopharyngeal swabs. Neither viral RNA nor viable virus was detected in the air sample at 0.5 m regardless of the oxygen-supplementation device. We detected viral RNA in two samples in the conventional nasal cannula group but not in the HFNC therapy group in gelatin filters located 3 m from the patient and the surface of the ventilation. This study directly demonstrated that despite viral RNA detection in the nasopharynx, viruses may not be dispersed by HFNC therapy. This warrants further research to determine if similar results can be obtained under different conditions.

Non-invasive positive pressure ventilation can reduce perioperative mortality in acute aortic dissection patients with hypoxemia.

Hypoxemia is a common critical respiratory complication in patients with acute aortic dissection (AAD) before operation and results in adverse outcomes. This study aimed to identify the optimal oxygenation treatment for AAD patients with hypoxemia in the emergency department (ED). This was a retrospective, observational, cohort study. We retrospectively collected data from 187 adult patients with AAD and hypoxemia who had been admitted to our ED. All patients were divided into nasal cannula group (n=91), Venturi mask group (n=60), and non-invasive positive pressure ventilation (NIPPV) group (n=36). The primary outcome was overall mortality in ED; the secondary outcomes were preoperative intubation rate and postoperative mortality, length of intensive care unit (ICU) stay, length of hospital stay, and length of intubation. Among all patients, those who received NIPPV treatment showed the lowest ED intubation rate (2.78%, P=0.004), shortest postoperative length of ICU stay (median 2.31, P<0.001), postoperative length of intubation (median 25.10, P<0.001), and post-operative length of hospital stay (median 21.00, P<0.001). Kaplan-Meier analysis showed the highest 3-day survival (log-rank 7.387, P=0.03) and 5-day survival (log-rank 14.710, P=0.001) in the NIPPV group. After adjustment, NIPPV therapy was independently associated with the reduced 3-day [adjusted hazard ratio (HR) 0.102, 95% confidence interval (CI): 0.013-0.791, P=0.03] and 5-day (adjusted HR 0.057, 95% CI: 0.008-0.427, P=0.005) mortality in ED. Early utilization of NIPPV in AAD patients with hypoxemia in the ED can effectively decrease pre-operative intubation rate and perioperative mortality, and improve postoperative outcomes.

Bilevel positive airway pressure for gastroscopy with sedation in patients at risk of hypoxemia: A prospective randomized controlled study

Study objectiveHypoxemia is one of the most frequent adverse events during sedated gastroscopy, and there is still no effective means to prevent and cure it. Therefore, we conducted this randomized trial to confirm our hypothesis that, compared with the nasal cannula group, bilevel positive airway pressure (BPAP) would decrease the incidence of hypoxemia in patients with obstructive sleep apnea (OSA) or overweight status undergoing gastroscopy. DesignIn a single-center, prospective, randomized controlled clinical trial, 80 patients aged 18–65 years and with OSA or overweight status who underwent gastroscopy with sedation were randomly assigned to two groups: the nasal cannula and BPAP groups. The primary outcome was the incidence of hypoxemia (75% < peripheral oxygen saturation [SpO2] < 90% for >5 sand <60 s). Main resultsCompared to the nasal cannula group, BPAP therapy significantly decreased the incidence of hypoxemia from 40.0% to 2.5% (absolute risk difference [ARD], 37.5% [95% confidence interval (CI), 21.6 to 53.4], p < 0.001), decreased subclinical respiratory depression from 52.5% to 22.5% (ARD, 30.0% [95% CI, 9.8 to 50.2], p = 0.006), and decreased severe hypoxemia from 17.5% to 0% (ARD, 17.5% [95% CI, 5.7 to 29.3], p = 0.006). The BPAP intervention also decreased the total propofol dosage and operation time and improved anesthesiologist's satisfaction. ConclusionBPAP therapy significantly decreased the incidence of hypoxemia in patients with OSA or overweight status who underwent gastroscopy.

Identification of the Optimal Position of a Nasal Oxygen Cannula for Apneic Oxygenation: A Technical Simulation.

In a cannot-ventilate-cannot-intubate situation, careful preoxygenation with high FiO2 allowing subsequent apneic oxygenation can be life-saving. The best position for an oxygen supply line within the human airway at which oxygen insufflation is more effective than standard preoxygenation with a face mask is unknown. In this experimental study, we compared the effectiveness of preoxygenation by placing an oxygen cannula at the nose entrance, through the nose at the soft palatine, or at the base of the tongue; as a control we used ambient air. We connected a fully preoxygenated test lung on one side to an oximeter with a flow rate of 200 mL/min simulating the oxygen consumption of a normal adult on the other side of the trachea of an anatomically correctly shaped airway manikin over a 20 min observation period five times for each cannula placement in a random order. The oxygen percentage in the test lung dropped from 100% in all groups to 53 ± 1% in the ambient air control group, to 87 ± 2% in the nasal cannula group, and to 96 ± 2% in the soft palatine group; it remained at 99 ± 1% in the base of the tongue group (p = 0.003 for the soft palatine vs. base of the tongue and p &lt; 0.001 for all other groups). When simulating apneic oxygenation in a preoxygenated manikin, oxygen insufflation at the base of the tongue kept the oxygen percentage at baseline values of 99%, demonstrating a complete block of ambient air flowing into the airway of the manikin. Oxygen insufflation at the soft palatine or insufflation via a nasal cannula were less effective regarding this effect.

Supraglottic jet oxygenation and ventilation decreased hypoxemia during gastrointestinal endoscopy under deep sedation at high altitudes: a randomized clinical trial

BackgroundHypobaric hypoxia is common at high altitudes. Whether this exacerbates hypoxia during procedural sedation and whether hypoxia can be alleviated by the use of supraglottic jet oxygenation and ventilation (SJOV) are unknown. This study aimed to compare the incidence of hypoxia during gastrointestinal endoscopy under deep sedation at high altitudes with oxygen supply techniques using either a nasal cannula or SJOV.MethodsThis study was conducted from April 2022 to July 2022 in a tertiary hospital located 3650 m above sea level. Adult patients scheduled for routine gastrointestinal endoscopy under sedation were enrolled and randomized 1:1 to receive SJOV or a nasal cannula during sedation. Moderate hypoxia was the primary outcome, defined as an SPO2 of 75–89% for < 60 s. The secondary outcomes were respiratory-, cardiovascular-, and SJOV-related complications. The influence of characteristics regarding acclimatization to high altitudes (Tibetan ethnic group and erythrocytosis) on the occurrence of hypoxia was analyzed.ResultsNone of the patients were lost to follow-up. A total of 72 patients were included in the analysis (36 patients in each group). There were 20 (27.8%) patients who experienced moderate hypoxia events. Significantly fewer hypoxic events occurred in the SJOV group than in the nasal cannula group [3 (8.3%) vs. 17 (47.2%), absolute risk difference (95% CI): − 38.9 (− 57.5, − 20.2) %, risk ratio (RR, 95% CI): 0.18 (0.06, 0.55), P < 0.001]. Significantly fewer patients in the SJOV group experienced mild hypoxia (P < 0.001) and severe hypoxia (P = 0.002). No serious adverse events occurred in either of the groups. The Tibetan ethnic group (P = 0.086) and erythrocytosis (P = 0.287) were not associated with the occurrence of hypoxia events.ConclusionsThe incidence of hypoxia was lower with SJOV than with nasal cannula in patients undergoing gastrointestinal endoscopy under deep sedation at high altitudes. The Tibetan ethnic group and erythrocytosis did not influence the occurrence of hypoxia.Trial registrationThis study was registered at ClinicalTrials.gov (NCT05304923) before enrollment by Dr. Yi Feng on 31/03/2022.

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Abstract 167: Nasal Sensor Capnographic Differences In Major Traumatic Brain Injury Patients Receiving Non-rebreather Mask Versus Nasal Cannula Oxygen Delivery

Background: The advent of highly sensitive End-Tidal CO2 (ETCO2) sensors allows effective monitoring of intubated patients in EMS. Previous work has explored the use of ETCO2 monitoring in non-intubated patients with sensors placed in the nares. However, little is known about the effect of passive O2 delivery [nasal cannula (NC) or high-flow, non-rebreather mask (NRB)] on ETCO2 measurement. Objective: To compare ETCO2 measurements in non-intubated Traumatic Brain Injury (TBI) patients receiving O2 via NC vs. NRB in the field. Methods: A subset of cases from the EPIC EMS TBI Study (NIH-1R01NS071049) were evaluated (4/13-4/18). Non-intubated cases from 5 EMS agencies providing monitor data, including continuous ETCO2. Start and end segments were excluded to remove artifact from initiation (“ramp-up”) or termination of monitoring. Statistics: Wilcoxon rank-sum test, two-sample t-test, and Chi-squared test were used as appropriate. Linear regression compared continuous variables in adjusted analyses (α = 0.05). Results: Included were 151 cases [median age: 52 (range: 9-91; 66% male)]. Of those, 62 (41%) received NCO2 and 89 (59%) via NRB. Patient-level mean ETCO2 was slightly lower in the NC group (mean = 26.9 mmHg; SD 6.7) compared to NRB (mean 30.2; SD 8.1; p=0.007). Differences in the mean were: Unadjusted: 3.3 (95% CI 0.9-5.7); Adjusted 2.7 (0.2-5.2). There were no significant differences in means of the patient-level lowest or highest recorded values. Conclusion: While there was a statistically lower ETCO2 in the NC versus NRB-oxygenated patients, it was around 3 mmHg and, thus, not clinically significant. This is surprising since: 1) the O2 flow rates and 2) the open-air (NC) versus mask (NRB) delivery methods are so dramatically different. Future study is needed to identify the clinical implications of using noninvasive ETCO2 measurement as a tool for monitoring ventilatory status and changes in non-intubated TBI (and other) patients in emergency settings.

Effect of high-flow nasal cannula therapy on thirst sensation and dry mouth after extubation: A single-centre prospective cohort study

ObjectivesLittle is known regarding the association between the type of oxygen therapy and thirst sensation after extubation. This study aimed to assess the effect of post-extubation high-flow nasal cannula on thirst. Research methodology/design and settingThis single-centre prospective cohort study included 100 ventilated patients. After extubation, patients received either high-flow nasal cannula (n = 19) or conventional oxygen therapy (n = 81). Thirst intensity was evaluated by a self-reporting numeric rating scale, and dry mouth was defined objectively using an oral moisture checking device. Main outcome measuresThe primary outcome was thirst intensity 24 hours post-extubation. Secondary outcomes were thirst intensity at 4 hours post-extubation and prevalence of dry mouth at 4 hours and 24 hours post-extubation. ResultsAt 24 hours post-extubation, the median (interquartile range) thirst intensity was 5 (1, 7) in the high-flow nasal cannula group and 5 (4, 6) in the conventional oxygen group. After adjustment, high-flow nasal cannula therapy was significantly associated with lower thirst intensity (adjusted odds ratio, 0.14; 95 % confidence interval (CI) 0.04–0.49; P = 0.002). At 4 hours post-extubation, high-flow nasal cannula was also associated with lower thirst intensity (adjusted odds ratio, 0.19; 95 % CI, 0.06–0.60; P = 0.005). The number of patients with dry mouth was not significantly different between the two groups (high-flow vs conventional oxygen therapy, 42.1 % vs 30.9 % [4 hours after extubation]; 47.4 % vs 34.6 % [24 hours after extubation]). ConclusionsHigh-flow nasal cannula therapy was associated with lower thirst intensity than conventional oxygen therapy following extubation. However, there was no significant difference in the prevalence of dry mouth.

A comparison of high-flow nasal cannula versus non-invasive positive pressure ventilation for respiratory support in infants following cardiac surgery.

Following cardiac surgery, infants often remain endotracheally intubated upon arrival to the cardiac ICU. High-flow nasal cannula and non-invasive positive pressure ventilation are used to support patients following extubation. There are limited data on the superiority of either mode to prevent extubation failure. We conducted a single-centre retrospective study for infants (<1 year) and/or <10 kg who underwent cardiac surgery between 3/2019-3/2020. Data included patient and clinical characteristics and operative variables. The study aimed to compare high-flow nasal cannula versus non-invasive positive pressure ventilation following extubation and their association with extubation failure. Secondarily, we examined risk factors associated with extubation failure. There were 424 patients who met inclusion criteria, 320 (75%) were extubated to high-flow nasal cannula, 104 (25%) to non-invasive positive pressure ventilation, and 64 patients (15%) failed extubation. The high-flow nasal cannula group had lower rates of extubation failure (11%, versus 29%, p = 0.001). Infants failing extubation were younger and had higher STAT score (p < 0.05). Compared to high-flow nasal cannula, non-invasive positive pressure ventilation patients were at 3.30 times higher odds of failing extubation after adjusting for patient factors (p < 0.0001). Extubation failure after cardiac surgery occurs in smaller, younger infants, and those with higher risk surgical procedures. Patients extubated to non-invasive positive pressure ventilation had 3.30 higher odds to fail extubation than patients extubated to high-flow nasal cannula. The optimal mode of respiratory support in this patient population is unknown.

Decreasing the Incidence of Hypoxia and Airway Maneuvers During GI Procedures.

Many outpatient gastrointestinal procedures are completed with propofol anesthesia. A side effect of propofol is airway obstruction and subsequent hypoxia. This study was designed to determine whether the use of a high-flow nasal cannula is associated with a decreased incidence of hypoxia or airway obstruction in patients undergoing propofol sedation in the gastrointestinal laboratory with a STOP-BANG score ≥5. High-flow nasal cannula was administered at 70 L/min on 27 patients with a STOP-BANG score ≥5 receiving monitored anesthesia care sedation for an esophagogastroduodenoscopy, endoscopic ultrasound, or colonoscopy procedure. Patients were compared to a group from a previous project without the use of high-flow nasal cannula assessing whether hypoxia, apnea, or the need for airway maneuvers occurred. The non-high-flow nasal cannula group required an airway maneuver 53.3% (n = 8) whereas the high-flow nasal cannula group required an airway maneuver 18.5% (n = 5) (p = .021). High-flow nasal cannula was associated with a reduced need for airway maneuvers in patients with a high risk of obstructive sleep apnea undergoing propofol-assisted procedures.

COMPARISON OF NON-INVASIVE MECHANICAL VENTILATION AND NASAL CANNULA USE IN DEEP SEDATION PROCEDURES PERFORMED FOR DENTAL TREATMENTS OF CHILDREN

For deep sedation procedures, supplemental oxygen is usually administered via a nasal cannula to the patients. Non-invasive mechanical ventilation (NIMV) is the oxygenation method, especially used in the treatment of hypoxia. We aimed to compare the use of nasal cannula and NIMV applications as oxygenation methods for deep sedation procedures in the dental treatments of children, especially in terms of patient safety and the convenience of the dentist to apply the treatment. Patients were divided into two groups as the nasal mask group (M) and the nasal cannula group (N). For oxygenation, while a nasal cannula was used for group N, NIMV with a nasal mask was applied for group M. Hemodynamic parameters of the patients, complications and dentist's satisfaction degree were recorded and compared. Saturation of blood oxygen (SpO2) was significantly higher in group M after induction of anesthesia and in the fifth minute of the procedure. Hypoxia (SpO2 ≤90) event number during the procedure was significantly higher in group N. Surgeon satisfaction was significantly higher in group M. We concluded that, in children undergoing deep sedation for dental treatments, NIMV applied with a nasal mask reduces the risk of hypoxia and is safer than using a nasal cannula.

Cardiac Arrhythmias and COVID-19: Correlation With Disease Severity.

BackgroundCardiac arrhythmia is one of the life-threatening cardiovascular complications commonly reported in patients hospitalized with coronavirus disease 2019 (COVID-19). We aimed to evaluate the association between cardiac arrhythmias and disease severity based on oxygen requirement.MethodsIn this retrospective observational chart review-based study we recruited 396 patients hospitalized with COVID-19 from March 2020 to May 2020 from two regional medical centers in New Jersey, USA. Patients’ baseline characteristics, secondary diagnoses, and laboratory findings were manually extracted and compared among two groups: patients with cardiac arrhythmias and those without. Poisson regression analysis was used to evaluate the correlation of cardiac arrhythmias and increased oxygen requirement, which are: room air (RA), nasal cannula (NC), high flow nasal cannula (HFNC), and bi-level positive airway pressure ventilation or invasive mechanical ventilation (BIPAP/MV).ResultsThe demographic characteristics of the patients were: aged 61 +/- 18.7 years (mean +/- standard deviation); with 56% being male, and 44.9% of African American race. There were 16% patients on RA, 40% on NC, 15% on HFNC, and 29% on BIPAP/MV. The incidence of cardiac arrhythmias was 36.7% (20% pulseless electrical activity (PEA), 13.5% atrial fibrillation (AF). 56% of AF was new-onset arrhythmia. Compared to the RA group, the risk of cardiac arrhythmias was significantly higher in BIPAP/MV (OR 3.3; 95% CI 1.8 - 6.2, p <0.001) and HFNC (OR 2.9; 95% CI 1.5-5.7, p0.001), but not in NC group (OR 0.95; 95% CI 0.4-1.8, p0.89).Compared to patients without arrhythmias, patients with arrhythmias were older (mean age 71 vs. 56 years, p <0.001) and had more comorbidities (Charlson comorbidity index (CCI), 4.7 vs. 2.9, p <0.001). The continued therapy of angiotensin-converting enzyme inhibitors or angiotensin-II receptor blockers did not seem to be associated with increased or decreased risk of cardiac arrhythmias.ConclusionThe incidence of cardiac arrhythmias among hospitalized COVID-19 patients was 36.7% with PEA being common in patients who succumbed to death, and AF in those patients who survived. The incidence of cardiac arrhythmias positively correlated with disease severity based on oxygen requirement and was higher among patients requiring HFNC or BIPAP/MV.

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

Hypoxia is the most frequently occurring adverse effect during endoscopic retrograde cholangiopancreatography (ERCP) under sedation; thus, oxygen must be properly supplied to prevent a reduction of oxygen saturation. In this study, we intend to verify the preventive effect for hypoxia during ERCP, using a high-flow nasal cannula (HFNC), in elderly patients. As a multicenter prospective randomized trial, patients who underwent ERCP with propofol-based sedation were randomly assigned into two groups: Patients in the HFNC group were supplied with oxygen via an HFNC, and those in the standard nasal cannula group were supplied with oxygen via a low-flow nasal cannula. The co-primary end points were the lowest oxygen saturation rate and hypoxia during the overall procedure. A total of 187 patients (HFNC group: 95; standard nasal cannula group: 92) were included in the analysis. Unexpected hypoxia events were more frequently observed among patients in the standard nasal cannula group than among patients in the HFNC group (13% vs. 4%, odds ratio 3.41, 95% confidence interval 1.06-11.00, p = 0.031). The mean of the lowest oxygen saturation rate during ERCP was significantly lower in the standard nasal cannula group than in the HFNC group (95% vs. 97%, p = 0.002). Oxygen supplementation with an HFNC can prevent oxygen desaturation and hypoxia events in patients undergoing ERCP under sedation. Trial registration Clinical Research Information Service (CRIS; KCT0004960).