Efficacy of high flow nasal oxygenation against hypoxemia in sedated patients receiving gastrointestinal endoscopic procedures: A systematic review and meta-analysis

doi:10.1016/j.jclinane.2022.110651

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Title:	Efficacy of high flow nasal oxygenation against hypoxemia in sedated patients receiving gastrointestinal endoscopic procedures: A systematic review and meta-analysis
Authors:	Hung, Kuo-Chuan Chang, Ying-Jen Chen, I-Wen Soong, Tien-Chou Ho, Chun-Ning Hsing, Chung-Hsi Chu, Chin-Chen Chen, Jen-Yin Sun, Cheuk-Kwan
Contributors:	Chi Mei Hospital Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy & Science Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy & Science E-Da Hospital E-Da Hospital I Shou University Chi Mei Hospital E-Da Hospital
Keywords:	randomized controlled-trial propofol-mediated sedation cannula oxygen myocardial-ischemia moderate sedation clinical-use upper airway anesthesia therapy safety
Date:	2022
Issue Date:	2023-12-11 14:00:59 (UTC+8)
Publisher:	ELSEVIER SCIENCE INC
Abstract:	Study objective: To evaluate the impact of high flow nasal oxygenation (HFNO) on the risk of hypoxemia during gastrointestinal endoscopic procedures (GEPs) under sedation. Design: Meta-analysis of randomized controlled trials. Setting: Gastrointestinal endoscopy. Intervention: HFNO. Patients: Adults patients undergoing GEPs under sedation. Measurements: The primary outcome was risk of hypoxemia, while the secondary outcomes included risks of severe hypoxemia, hypercapnia, need for jaw thrust or other airway interventions, and procedural interruption as well as procedure time, minimum SpO(2), and level of carbon dioxide (CO2). Analyses based on age, gender, flow rate, risk status of patients were performed to investigate subgroup effects. Results: Medline, Google scholar, Cochrane Library, and EMBASE databases were searched from inception to July 2021. Seven randomized controlled trials (RCTs) involving 2998 patients published from 2019 to 2021 were included. All GEPs were performed under propofol sedation. Pooled results revealed significantly lower risks of hypoxemia [relative risk (RR) = 0.31, 95% CI:0.13-0.75; 2998 patients], severe hypoxemia (RR = 0.38, 95% CI:0.2-0.74; 2766 patients), other airway interventions (RR = 0.34, 95% CI:0.22-0.52; 2736 patients), procedural interruption (RR = 0.12, 95% CI:0.02-0.64, 451 patients) and a lower CO2 level [standard mean difference (MD) =-0.21, 95% CI:-0.4 to-0.03; 458 patients] in HFNO group compared to control group. Subgroup analysis focusing on risk of hypoxemia showed no significant subgroup effects, indicating consistent benefits of HFNO in different clinical settings. There were no difference in minimum SpO(2) (p = 0.06; 262 patients), risk of hypercapnia (p = 0.09; 393 patients), need for jaw thrust (p = 0.28; 2256 patients), and procedure time (p = 0.41, 1004 patients) between the two groups. Conclusion: Our results demonstrated the efficacy of high flow nasal oxygenation for reducing the risk of hyp-oxemia in patients receiving elective gastrointestinal endoscopic procedures under sedation. Further studies are warranted to verify its cost-effectiveness in the gastrointestinal endoscopy setting.
Relation:	Journal of Clinical Anesthesia, v.77, Article 110651
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles

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