High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial

Jacob Rosen; Peter Frykholm; Diddi Fors

doi:10.1111/aas.13960

journal article Open Access Aug 12, 2021

High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial

Jacob Rosen

Peter Frykholm

Diddi Fors

Acta Anaesthesiologica Scandinavica Vol. 65 No. 10 pp. 1381-1389 · Wiley

View at Publisher Save 10.1111/aas.13960

Abstract

AbstractBackgroundPreoxygenation efficacy with high‐flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high‐flow nasal cannula with face mask for preoxygenation in this population.MethodsWe conducted a single‐centre, randomised, controlled trial. Forty subjects with BMI ≥ 35 kg m−2 were randomly assigned to receive 5.0 min of preoxygenation with face mask and 7 cm H2O of PEEP (PEEP group) or HFNC at 70 L min−1 (HF group). Following induction, bag‐mask ventilation continued until laryngoscopy, whereas HFNC was maintained before and during intubation. The primary outcomes were end‐tidal fraction of oxygen (EtO2) at 2.5 and 5.0 min duration of preoxygenation. Secondary outcomes included PaO2 and PaCO2 at 2.5 and 5.0 min of preoxygenation and at intubation.ResultsMean (±SD) EtO2 was 0.89 (±0.04) versus 0.90 (±0.05) after 2.5 min (95% CI for mean difference −0.02, 0.04) and 0.93 (±0.02) versus 0.91 (±0.02) after 5.0 min of preoxygenation (95% CI for mean difference −0.03, −0.002) in the PEEP (n = 18) and HF group (n = 20), respectively. All subjects reached an EtO2 ≥ 0.85 at 5.0 min. There were no differences in mean PaO2 or PaCO2 during preoxygenation. Subjects in the HF group had a mean (±SD) apnoea time of 199 (±38) s, but no desaturation (SpO2 < 100%) occurred.ConclusionsFace mask with PEEP was superior to HFNC for preoxygenation in obese subjects. HFNC provided adequate preoxygenation quality in all subjects and may be considered as an alternative to face mask in selected patients.Trial registration#ISRCTN37375068 (www.isrctn.com).

Topics

No keywords indexed for this article. Browse by subject →

References

38

[1]

10.1093/bja/67.4.464

[2]

10.1213/00000539-199101000-00016

[3]

10.1111/anae.13101

[4]

10.1093/bja/60.5.574

[5]

10.1213/00000539-199809000-00031

[6]

Zavala DC "Basal and exercise tests on morbidly obese patients before and after gastric bypass" Surgery (1984)

[7]

10.1097/aln.0b013e318194cac8

[8]

10.1093/bja/aeu373

[9]

10.1097/aln.0b013e31819b5b87

[10]

10.1177/0310057x9101900206

[11]

10.1093/bja/64.5.571

[12]

10.1097/00000542-200506000-00009

[13]

10.1213/ane.0b013e318183909b

[14]

10.1213/01.ane.0000143339.40385.1b

[15]

10.1097/aln.0b013e31821811ba

[16]

10.1093/bja/75.6.777

[17]

10.1007/bf03021532

[18]

Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients

A. Corley, L.R. Caruana, A.G. Barnett et al.

British Journal of Anaesthesia 10.1093/bja/aer265

[19]

10.4187/respcare.02086

[20]

10.1016/j.aucc.2007.08.001

[21]

10.1093/bja/aep280

[22]

10.1177/0310057x1103900620

[23]

10.1213/ane.0000000000003966

[24]

Heinrich S "Benefits of heated and humidified high flow nasal oxygen for preoxygenation in morbidly obese patients undergoing bariatric surgery: a randomized controlled study" J Obes Bariatrics (2014)

[25]

10.1093/bja/aex016

[26]

10.1016/j.bja.2018.08.015

[27]

10.1016/j.eclinm.2019.05.014

[28]

10.4187/respcare.04028

[29]

10.1152/japplphysiol.00584.2016

[30]

10.1177/0310057x9302100406

[31]

10.1159/000444418

[32]

10.1213/01.ane.0000096261.89531.90

[33]

10.1111/anae.12923

[34]

10.1093/bja/aex036

[35]

10.1097/eja.0000000000001395

[36]

10.1007/s00134-019-05529-w

[37]

10.1007/s00134-015-3796-z

[38]

10.1007/s00134-016-4588-9

Metrics

23

Citations

38

References

Details

Published: Aug 12, 2021
Vol/Issue: 65(10)
Pages: 1381-1389
License: View

Authors

J

Jacob Rosen

Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden

P

Peter Frykholm

Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden

D

Diddi Fors

Department of Surgical Sciences, Section of Anaesthesiology and Intensive Care Medicine Uppsala University Uppsala Sweden

Cite This Article

Jacob Rosen, Peter Frykholm, Diddi Fors (2021). High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial. Acta Anaesthesiologica Scandinavica, 65(10), 1381-1389. https://doi.org/10.1111/aas.13960

High‐flow nasal cannula versus face mask for preoxygenation in obese patients: A randomised controlled trial

You May Also Like