Incidence of hypoxemia with high-flow nasal oxygenation versus facemask oxygenation in patients at risk of hypoxemia undergoing bronchoscopy: A randomised controlled trial

Background: Patients at high risk of obstructive sleep apnea (OSA) are prone to hypoxemia during sedated bronchoscopy. The present study aimed to investigate whether high-flow nasal oxygenation (HFNO) reduces the incidence of hypoxemia in patients at high risk of OSA undergoing bronchoscopy under deep sedation. Methods: : A total of 176 patients at high risk of OSA who underwent bronchoscopy under deep sedation were randomly assigned into two groups: the HFNO group (humidified oxygen was supplied via a high-flow nasal cannula at a rate of 60 L/min and a concentration of 100%, n = 87) and the Facemask group (oxygen was supplied via tight-fitting facemask at a rate of 6 L/min and a concentration of 100%, n = 89). Results: : Hypoxemia occurred in 4 (4.6%) patients in the HFNO group and 26 (29.2%) patients in the Facemask group ( P < 0.001). The Facemask group required more jaw thrust maneuvers than the HFNO group (48.3% vs 5.7%, P < 0.001). A total of 9.0% of the patients in the Facemask group and no one in the HFNO group required bag-mask ventilation ( P = 0.012). Conclusions: : HFNO can reduce the incidence of hypoxemia and the requirement of airway intervention in patients at high risk of OSA during bronchoscopy under deep sedation. Trial registration: www.chiCTR.org.cn Identifier: ChiCTR2100044105. Registered 11/03/2021.