British journal of anaesthesia · 2025
Preoxygenation with high-flow nasal oxygen at various flow rates in elective surgical patients: a prospective, randomised, single-blind clinical trial.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Sjöblom Albin, Hoffman Frida, Hedberg Magnus, Forsberg Ida-Maria, Jonsson Fagerlund Malin
Аннотация
BACKGROUND: High-flow nasal oxygen (HFNO) is increasingly used for preoxygenation. Previous studies of preoxygenation have explored flow rates below 60 L min-1. This study aimed to compare different HFNO flow rates during preoxygenation to identify the most effective flow rate for clinical use.
METHODS: This randomised trial included patients aged 18-84 yr of ASA physical status 1-3 scheduled for elective surgery. Preoxygenation was conducted using HFNO at randomised flow rates of 45, 70, or 95 L min-1. After preoxygenation, patients rated their level of preoxygenation-related discomfort. HFNO was discontinued at apnoea start. After intubation, apnoea was maintained until Spo2 reached 93%. Primary outcome was apnoea time until Spo2=93%. Secondary outcomes were Pao2 levels during preoxygenation and preoxygenation-related discomfort.
RESULTS: Of 72 participants included in the final analysis, baseline characteristics were similar and the mean duration of preoxygenation was 250 s in all three groups. Apnoea times did not differ, with median durations of 472, 523, and 483 s for 45, 70, and 95 L min-1, respectively (P=0.59). At apnoea onset, 95 L min-1 produced higher Pao2 than 45 L min-1. No other differences in Pao2 were observed during preoxygenation. The level of discomfort was lower for 45 L min-1 compared with 70 and 95 L min-1.
CONCLUSIONS: There was no difference in the safe apnoea time between preoxygenation with the three flow rates. As 45 L min-1 generated the least discomfort while providing preoxygenation effectiveness comparable with higher flow rates, increasing preoxygenation flow rate from 45 to 70 L min-1 will likely not prolong safe apnoea time.
CLINICAL TRIAL REGISTRATION: NCT06736132.
METHODS: This randomised trial included patients aged 18-84 yr of ASA physical status 1-3 scheduled for elective surgery. Preoxygenation was conducted using HFNO at randomised flow rates of 45, 70, or 95 L min-1. After preoxygenation, patients rated their level of preoxygenation-related discomfort. HFNO was discontinued at apnoea start. After intubation, apnoea was maintained until Spo2 reached 93%. Primary outcome was apnoea time until Spo2=93%. Secondary outcomes were Pao2 levels during preoxygenation and preoxygenation-related discomfort.
RESULTS: Of 72 participants included in the final analysis, baseline characteristics were similar and the mean duration of preoxygenation was 250 s in all three groups. Apnoea times did not differ, with median durations of 472, 523, and 483 s for 45, 70, and 95 L min-1, respectively (P=0.59). At apnoea onset, 95 L min-1 produced higher Pao2 than 45 L min-1. No other differences in Pao2 were observed during preoxygenation. The level of discomfort was lower for 45 L min-1 compared with 70 and 95 L min-1.
CONCLUSIONS: There was no difference in the safe apnoea time between preoxygenation with the three flow rates. As 45 L min-1 generated the least discomfort while providing preoxygenation effectiveness comparable with higher flow rates, increasing preoxygenation flow rate from 45 to 70 L min-1 will likely not prolong safe apnoea time.
CLINICAL TRIAL REGISTRATION: NCT06736132.