Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  29 (2025)
Volume  28 (2024)
Volume  27 (2023)
Volume  26 (2022)
Volume  25 (2021)
Volume  24 (2020)
Volume  23 (2019)
Volume  22 (2018)
Volume  21 (2017)
Volume  20 (2016)
Volume  19 (2015)
Volume  18 (2014)
Volume  17 (2013)
Volume  16 (2012)
Volume  15 (2011)
Volume  14 (2010)
Volume  13 (2009)
Volume  12 (2008)
Volume  11 (2007)
Volume  10 (2006)
Volume  9 (2005)
Volume  8 (2004)
Related articles

VOLUME 29 , ISSUE 3 ( March, 2025 ) > List of Articles

Original Article

HFNC Oxygen Therapy vs COT in Prolonged Upper Gastrointestinal Endoscopy Inside the ICU: A Prospective, Randomized, Controlled Clinical Study

Ahmed M Mohamed, Wessam Z Selima

Keywords : Conventional nasal cannula oxygen therapy, High-flow nasal cannula oxygen therapy, Hypoxemia, Intensive care unit, Randomized clinical trial, Sedation, Upper gastrointestinal endoscopy

Citation Information : Mohamed AM, Selima WZ. HFNC Oxygen Therapy vs COT in Prolonged Upper Gastrointestinal Endoscopy Inside the ICU: A Prospective, Randomized, Controlled Clinical Study. Indian J Crit Care Med 2025; 29 (3):223-229.

DOI: 10.5005/jp-journals-10071-24919

License: CC BY-NC 4.0

Published Online: 28-02-2025

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

Aims and background: Hypoxemia is a common and serious complication occurring during deep sedation for prolonged upper gastrointestinal endoscopy (UGE). We evaluated and compared the efficacy of high-flow nasal cannula (HFNC) oxygen therapy vs conventional nasal cannula oxygen therapy (COT) in preventing hypoxemia in patients admitted to the intensive care unit (ICU) and who underwent prolonged (>15 minutes) UGE under deep sedation. Materials and methods: Seventy patients aged 20–60 years with American Society of Anesthesia (ASA) I, II, or III who were admitted to the ICU and were scheduled for an anticipated prolonged UGE were included. They were randomly assigned to be administered either oxygen through a standard nasal cannula (COT group) or oxygen through an HFNC (HFNC group). The primary outcome was any occurrence of at least moderate hypoxemic episodes [oxygen saturation (SpO2) < 90%] of any duration. Results: Regarding the occurrence of hypoxemic episodes, 18 patients (51.4%) in the COT group experienced hypoxemia with 11 (31.4%) experiencing mild hypoxemia, six (17.1%) experiencing moderate hypoxemia, and only one patient (2.9%) experienced severe hypoxemia, with a total of seven patients (20.0%) whose SpO2 was <90%. Conversely, only two patients (5.7%) in the HFNC group had mild hypoxemia, and no patients had SpO2 < 90%. Additionally, nine patients in the COT group experienced clinically significant hypoxemia, whereas no patients in the HFNC group (p = 0.001). Conclusion: High-flow nasal cannula (HFNC) oxygen therapy was safe, well tolerated, and significantly decreased the incidence of hypoxemic episodes, compared to COT, among high-risk ICU patients who underwent prolonged UGE under propofol deep sedation. (Registered at ClinicalTrials.gov with ID: NCT06350864)

PDF Share
  1. Sidhu R, Turnbull D, Newton M, Thomas-Gibson S, Sanders DS, Hebbar S, et al. Deep sedation and anesthesia in complex gastrointestinal endoscopy: A joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anesthetists (RCoA). Frontline Gastroenterol 2019;10:141–147. DOI: 10.1136/flgastro-2018-101145.
  2. Eugene A, Fromont L, Auvet A, Baert O, Mfam W, Remerand F, et al. High-flow nasal oxygenation versus standard oxygenation for gastrointestinal endoscopy with sedation. The prospective multicenter randomized controlled ODEPHI study protocol. BMJ Open 2020;10:e034701. DOI: 10.1136/bmjopen-2019-034701.
  3. Lin Y, Zhang X, Li L, Wei M, Zhao B, Wang X, et al. High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: A randomized multicenter clinical trial. Gastrointest Endosc 2019;90:591–601. DOI:10.1016/j.gie.2019.06.033.
  4. Kim HJ, Asai T. High-flow nasal oxygenation for Anesthetic management. Korean J Anesthesiol 2019;72:527–547. DOI: 10.4097/kja.19174.
  5. Renda T, Corrado A, Iskandar G, Pelaia G, Abdalla K, Navalesi P. High-flow nasal oxygen therapy in intensive care and Anesthesia. Br J Anaesth 2018;120:18–27. DOI: 10.1016/j.bja.2017.11.010.
  6. Aggarwal A, Arora U, Mittal A, Aggarwal A, Singh K, Ray A, et al. Outcomes of HFNC use in COVID-19 patients in non-ICU settings: A single-center experience. Indian J Crit Care Med 2022;26(4):530–532. DOI: 10.5005/jp-journals-10071-24186.
  7. Jonathan Ng, Pu LZ, Be KH, Pearce B, Lee M, Fletcher L, et al. High-flow nasal cannula oxygen therapy versus conventional oxygen therapy in prolonged upper GI endoscopy: A randomized controlled trial. iGIE 2023;2:131–138. DOI: 10.1016/j.igie.2023.02.002.
  8. Möller W, Celik G, Feng S, Bartenstein P, Meyer G, Oliver E, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol 2015;118(12): 1525–1532. DOI: 10.1152/japplphysiol.00934.2014.
  9. Gustafsson I-M, A Lodenius, Tunelli J, Ullman J, Jonsson Fagerlund M. Apneic oxygenation in adults under general anesthesia using trans-nasal humidified rapid insufflations ventilatory exchange (THRIVE): A physiological study. Br J Anaesth 2017;118:610–617. DOI: 10.1093/bja/aex036.
  10. Wettstein RB, Shelledy DC, Peters JI. Delivered oxygen concentrations using low-flow and high-flow nasal cannulas. Respir Care 2005;50:604–609. PMID: 15871753.
  11. Mazzeffi MA, Petrick KM, Magder L, Greenwald BD, Darwin P, Goldberg EM, et al. High-flow nasal cannula oxygen in patients having anesthesia for advanced esophagogastroduodenoscopy: Hiflow-endo, a randomized clinical trial. Anesth Analg 2020;132:743–751. DOI: 10.1213/ANE.0000000000004837.
  12. Riccio CA, Sarmiento S, Minhajuddin A, Nasir D, Fox AA. High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: A prospective, randomized clinical trial. J Clin Anesth 2019;54:19–24. DOI: 10.1016/j.jclinane.2018.10.026.
  13. Teng WN, Ting CK, Wang YT, Hou MC, Chang WK, Tsou MY, et al. High-flow nasal cannula and mandibular advancement bite block decrease hypoxic events during sedative esophagogastroduodenoscopy: A randomized clinical trial. BioMed Res Int 2019;2019:4206795. DOI: 10.1155/2019/4206795.
  14. Wagstaff TA, Soni N. Performance of six types of oxygen delivery devices at varying respiratory rates. Anesthesia 2007;62:492–503. DOI: 10.1111/j.1365-2044.2007.05026.x.
  15. Nay MA, Fromont L, Eugene A, Marcueyz JL, Mfam WS, Baert O, et al. High-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation in patients at risk of Hypoxemia: A multicenter randomized controlled trial (ODEPHI trial). Br J Anaesth 2021;127:133–142. DOI: 10.1016/j.bja.2021.03.020.
  16. Behrens A, Kreuzmayr A, Manner H, Koop H, Lorenz A, Schaefer C, et al. Acute sedation-associated complications in GI endoscopy (ProSed 2 Study): Results from the prospective multicenter electronic registry of sedation-associated complications Gut 2019;68:445–452. DOI: 10.1136/gutjnl-2015-311037.
  17. Chang Y, Kim T-G, Chung S-Y. High-flow nasal cannula-induced tension pneumocephalus. Indian J Crit Care Med 2020;24(7):592–595. DOI: 10.5005/jp-journals-10071-23482.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.