An RCT to compare high flow nasal cannula with standard nasal cannula to prevent desaturation in subjects undergoing EBUS-TBNA: HIFLO-EBUS trial.

BACKGROUND AND

OBJECTIVE

Oxygen desaturation events occur commonly during Endobronchial endobronchial ultrasound (EBUS) guided-transbronchial needle aspiration (TBNA) performed under conscious sedation. We hypothesized that high-flow nasal cannula (HFNC) would be superior to conventional nasal cannula (NC) in preventing these hypoxemic episodes.

METHODS

We randomized consecutive subjects ≥18 years undergoing EBUS-TBNA to receive oxygen with HFNC or NC. The primary objective was to compare the proportion of subjects experiencing oxygen desaturation events (defined as SPO2 < 90% for at least 30 sec) during the EBUS-TBNA procedure between the two study arms. The key secondary outcomes were the number of desaturation events during the procedure and patient comfort on a visual analogue scale (VAS [0 mm-100 mm]).

RESULTS

We randomized 300 subjects (150 in each arm). The mean ± SD age of the study population (129 [43%] females) was 46.5 ± 14 years. The proportion of subjects experiencing clinically significant hypoxemic episodes was significantly (P < 0.0001) higher in NC (42.7% [64/150]) than in the HFNC (20% [30/150]) arm. The median nadir SPO2 was significantly lower in the NC arm than in HFNC (91% vs. 93%, P < 0.0001). The use of HFNC during EBUS-TBNA resulted in fewer desaturation events (mean difference [95% confidence interval], 0.55 [0.22-0.88]) and better patient comfort (mean difference in VAS, 7.1 [4.3 mm-9.9 mm]). We found no difference in the complication rates.

CONCLUSION

HFNC during EBUS reduced the number of subjects experiencing clinically significant hypoxemia, the number of desaturation events, and improved patient comfort compared to conventional oxygen therapy.