Efficacy of High Flow Nasal Cannula in Reducing Hypoxemia in Children Undergoing Elective Flexible Fibreoptic Bronchoscopy as Compared to Conventional Low Flow Nasal Cannula: A Randomized Controlled Trial.

BACKGROUND

Flexible fibreoptic bronchoscopy (FFB) is widely used in pediatric pulmonology, though hypoxemia remains a primary concern during the procedure. High-flow nasal cannula (HFNC) has shown potential in reducing hypoxemia in adults undergoing FFB. This study evaluates the efficacy and safety of HFNC versus low-flow nasal cannula (LFNC) for preventing hypoxemia during elective FFB in children.

METHODS

Children aged 1 month to 18 years scheduled for elective FFB were enrolled, excluding those ineligible for sedation or requiring prior respiratory support. Participants were randomized to HFNC or LFNC groups. The Chi-Square test was used for bivariate analysis; Yates' correction or Fisher's exact test was applied where assumptions were violated. Multivariate analysis was performed to identify clinically significant factors associated with hypoxemia.

RESULTS

Of 206 screened children, 122 were randomized (54.1% male; median age 39 months), with 61 in each group. Hypoxemia occurred in 37 (60.66%) HFNC and 34 (55.74%) LFNC patients, with no significant difference (p = 0.59; OR: 0.59-2.53). Complication rates-bradycardia, tachycardia, bradypnea, tachypnea, laryngospasm, and blood pressure changes were similar in both groups. Among those undergoing BAL, hypoxemia did not differ between groups (p = 0.57). No HFNC patient required resuscitation, whereas three LFNC patients developed apnea, interrupting the procedure. Multivariable analysis showed no independent predictors of hypoxemia severity (age, anemia, sedation depth; all p > 0.05).

CONCLUSION

HFNC did not show superiority over LFNC in preventing hypoxemia during elective FFB in children, however, the study may have been underpowered to detect modest differences.

CLINICAL TRIAL REGISTRATION: Clinical Trials Registry-India (CTRI) Registration No: CTRI/2022/08/044772 Dated: 22-08-2022). URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=71295&EncHid=72590.52664&modid=1&compid=19.