Effect of high flow nasal cannula oxygenation on incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity: multicentre randomised controlled trial.
Summary
In 984 obese adults undergoing sedated gastrointestinal endoscopy, HFNC oxygenation reduced hypoxia from 21.2% to 2.0% and eliminated severe hypoxia, without increasing adverse events. Subclinical respiratory depression also declined markedly with HFNC.
Key Findings
- HFNC reduced hypoxia from 21.2% (103/487) to 2.0% (10/497); P<0.001.
- Severe hypoxia decreased from 4.1% (20/487) to 0%; P<0.001.
- Subclinical respiratory depression fell from 36.3% to 5.6%; P<0.001.
- No increase in other sedation-related adverse events with HFNC.
Clinical Implications
For obese patients undergoing sedated endoscopy, consider routine HFNC to reduce hypoxia and rescue interventions; protocols should address device availability, flow settings, and staff training.
Why It Matters
This large multicenter RCT provides definitive evidence to adopt HFNC for high-risk obese patients during sedated endoscopy to improve respiratory safety. The magnitude of benefit and elimination of severe hypoxia support practice change.
Limitations
- Conducted in three tertiary centers in China; generalizability to other settings requires verification.
- Details of sedation protocols and HFNC settings may vary across centers.
Future Directions
Cost-effectiveness analyses, evaluation in non-obese high-risk groups, and protocolization of HFNC flow/FiO2 to standardize implementation.
Study Information
- Study Type
- RCT
- Research Domain
- Treatment
- Evidence Level
- I - High-quality multicenter randomized controlled trial
- Study Design
- OTHER