Effect of High-Flow Nasal Cannula Oxygen Therapy On The Postoperative Atelectasis in Interventional Sclerotherapy: A Randomized Controlled Trial

Effect of High-Flow Nasal Cannula Oxygen Therapy On The Postoperative Atelectasis in Interventional Sclerotherapy: A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of High-Flow Nasal Cannula Oxygen Therapy On The Postoperative Atelectasis in Interventional Sclerotherapy: A Randomized Controlled Trial Mai Zifeng, Zhuo Ming, Zhang Longfei, Luo Hao, Han Rui, Wang Lifeng, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6452369/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Anesthesiology → Version 1 posted 14 You are reading this latest preprint version Abstract Objective Children undergoing interventional treatment for vascular malformations (VMs) can easily develop perioperative atelectasis. High-flow nasal cannula (HFNC) oxygen therapy shows the potential to reduce perioperative atelectasis. The aim of our study was to explore the potential efficacy of HFNC oxygen therapy for reducing the incidence of perioperative atelectasis in Pediatric interventional treatment for vascular malformations. Methods This study was a prospective randomized controlled trial with patientblind structure. A total of 81 pediatric patients scheduled for interventional sclerotherapy for VMs were randomly divided into three groups: the mask oxygenation group (Group M) (n = 27), the endotracheal intubation group (Group T) (n = 27), and the HFNC group (Group H) (n = 27). The incidence of atelectasis was assessed at T 1 (at the end of surgery) and T 2 (upon discharge from the PACU).Other intraoperative and postoperative outcomes were also evaluated. Results A total of 80 pediatric surgical patients were included (26 patients in Group M, 27 patients in Group T, and 27 patients in Group H). At T 2 , significant atelectasis was observed in 17, 24, and 24 pediatric patients in Groups H, M, and T, respectively (63% vs. 88.9% vs. 92.3%; P = 0.011). The awakening time, PAED score, incidence of agitation during awakening, and incidence of postoperative nausea and vomiting in Group M and Group H were significantly lower than those in Group T ( P < 0.05). Conclusion HFNC oxygen therapy can reduce the incidence of atelectasis after pediatric interventional procedures for vascular malformations, prevent excessive CO 2 retention and other adverse reactions. Trial Registration: Chinese Clinical Trial Registration number: ChiCTR2300078634 Lung Ultrasonography Atelectasis Pediatric Anesthesia HFNC Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Interventional sclerotherapy under digital subtraction angiography guidance has become an important treatment method for vascular malformations. [ 2 ] Further more, since pediatric patients typically require general anesthesia for such surgeries, the incidence of atelectasis after tracheal intubation under general anesthesia can be as high as 68–100% owing to the low functional residual capacity in children. [ 3 ] Studies have revealed that, in children, perioperative atelectasis negatively affects oxygenation [ 6 ] and increases the risk of postoperative pulmonary complications (PPCs), such as pneumonia and acute lung injury, thus prolonging the recovery time. [ 7 , 8 ] Thus, better ventilation strategies that can be used under general anesthesia are needed to reduce the incidence of perioperative atelectasis and decrease the risk of PPCs. In recent years, HFNC oxygen therapy has attracted attention because of its ability to create positive pressure in the airway by delivering a high concentration of heated and humidified oxygen continuously. [ 9 ] Researchers reported that HFNC therapy is frequently used in anesthesia for short procedures [ 10 ] and that it improves respiratory function in children by increasing oxygenation and therefore reduces the incidence of perioperative atelectasis. [ 11 – 13 ] However, there is a lack of relevant research on the application of HFNC oxygen therapy in pediatric interventional treatment for vascular malformations. During pediatric surgery under anesthesia, although the HFNC delivers PEEP, which in turn improves oxygenation, its effectiveness for preventing atelectasis during surgery remains unclear. In pediatric patients with vascular malformations undergoing interventional sclerotherapy under general anesthesia, significant atelectasis, which can be detected via LUS. [ 14 ] Therefore, the aims of our study were to explore the potential of HFNC oxygen therapy for reducing the incidence of atelectasis. METHODS Study design and patient recruitment The study was conducted in the Department of Anesthesiology of the First Affiliated Hospital of Gannan Medical University from January 2024 to December 2024. Pediatric patients aged between 1 and 6 years, with an American Society of Anesthesiologists (ASA) physical status classification I-II, a body mass index (BMI) less than 19.8 kg/m², who underwent DSA-guided interventional sclerotherapy for VM and provided written informed consent were included in the study. The exclusion criteria were as follows: refusal by the child or their family; nasal anatomical abnormalities; a history of thoracic surgery; severe cardiac, pulmonary, hepatic, or renal disease; and a preoperative LUS score > 2. The additional exclusion criteria were: changes to the anesthesia method or surgical plan for any reason, or the inability to cooperate with the lung ultrasound examination. For this randomized, prospective, controlled study, 80 pediatric patients were recruited and randomly assigned to three groups: Group M, Group T, and Group H. The random number generator in SPSS 25.0 software was used. A fixed random number seed of 20240101 was set, and then the random function was used to generate random numbers for each patient. The SPSS visual binning function was then used to randomly assign the patients to the respective groups. The anesthesiologists were handed sealed envelopes containing the group information and selected the corresponding anesthesia method for ventilation and surgery. Professionally-trained anesthesiologists calculated the LUS, and neither the anesthesiologist who was responsible for calculating the LUS nor the parents/guardians were aware of the group information. The primary outcome was the incidence of significant atelectasis at T 1 and T 2 . The secondary outcomes included the LUS at T 0 , T 1 , and T 2 ; the results of the arterial blood gas analysis (ABGA) at T0 and T1; the incidence of intraoperative and postoperative hypoxemia (SpO 2 10); the postoperative awakening time (the time from the discontinuation of medication administration to the time of first eye opening or crying); the incidence of perioperative adverse reactions (such as aspiration, hoarseness, nausea, and vomiting); and the severity of pulmonary complications within seven days after surgery (grades 0–4). Grade 0 represents no PPCs; grade 1 indicates dry cough, minor atelectasis accompanied by fever and difficulty breathing, etc.; grade 2 indicates cough, hypoxemia, severe atelectasis accompanied by fever, etc.; grade 3 indicates pleural effusion, pneumonia, and the need for reintubation after surgery; and grade 4 indicates respiratory failure. [ 15 ] If SpO 2 falls below 92% perioperatively, we use the chin lift method to ensure ventilation. If SpO 2 continues to decrease or remains below this threshold for more than 5 minutes, we perform endotracheal intubation and exclude the patient from the study. Anesthesia methods The parents of the children included in the study signed informed consent forms before surgery. No food or fluid intake was allowed prior to surgery (solid food for 8 hours, milk for 6 hours, breast milk for 4 hours, or water for 2 hours). Intravenous access was established before surgery. Each patient’s ECG, SpO 2 , and MAP were monitored shortly after arriving at the operating room. In Group M, 4 µg/kg fentanyl and 2.5 ~ 4 mg/kg propofol were slowly injected in sequence, and the patient's eyelash reflex disappeared with a fixed mask. Ventilation was set at 10 L/min. In Group T, 4 µg/kg fentanyl and 2.5 ~ 4 mg/kg propofol were slowly injected in sequence, and after the patient's eyelash reflex disappeared, 0.6 mg/kg rocuronium bromide was slowly injected. Tracheal intubation was performed 2 minutes later, and after the tube was confirmed to be in the appropriate position via auscultation, it was fixed. The settings were as follows: VT 8 ml/kg, I/E = 1:2, and the respiratory rate was adjusted to maintain the P ET CO 2 at 35 ~ 45 mmHg. In Group H, 4 µg/kg fentanyl and 2.5 ~ 4 mg/kg propofol were slowly injected in sequence, and after the patient's eyelash reflex disappeared, a dedicated HFNC nasal cannula was fixed. Oxygen was administered according to the patient's weight (5 ~ 15 kg, 2 L/kg/min; 15 ~ 30 kg, 35 L/min) [ 16 ] . All three groups were ventilated with pure oxygen. After surgery, the patient was transferred to the postanesthesia care unit. After the patients in Groups T, H, and M were extubated upon arrival to the postanesthesia care unit, nasal oxygen therapy was started. No antagonists were used during the recovery period, and the patient was sent back to the ward when the Steward score was ≥ 4. If the patient had significant body movements during surgery, 2 mg/kg propofol was administered intravenously; if the patient’s SpO 2 fell below 92%, mask-assisted ventilation was given; if the patient’s HR fell below 80 beats per minute, 0.01 mg/kg atropine was administered intravenously. Lung ultrasonography Lung ultrasound examinations were conducted at three time points: T 0 , T 1 , and T 2 . An anesthesiologist with extensive experience in lung ultrasound examinations used an M-7 ultrasound system (Mindray, Shenzhen, China) equipped with a high-frequency linear array transducer (8–12 MHz) to longitudinally scan the patient from the caudal to the cephalic direction. [ 17 ] The patients were examined in the supine or lateral decubitus position according to the twelve-zone method. The thorax was divided into two hemithoraces by two short-axis lines (one line above the diaphragm plane and the other line 1 cm above the line connecting the two nipples), and each hemithorax was further divided into six regions by three long-axis lines (the anterior midline, the left and right anterior axillary lines, and the left and right posterior axillary lines). During the examination, the probe was kept parallel to the ribs, and the severity of pleural consolidation was scored from 0 to 3 (0 indicating normal pleura without consolidation; 1 indicating small areas of consolidation beneath the pleura; 2 indicating moderate areas of consolidation beneath the pleura; 3 indicating large areas of consolidation beneath the pleura) [18]; the B-line score ranged from 0 to 3 (0 indicating A-lines, isolated B-lines less than 3; 1 indicating isolated B-lines more than 3; 2 indicating coalescent B-lines; 3 indicating white lung). [ 18 ] Significant atelectasis was defined as a pleural consolidation score ≥ 2 in any region. [ 19 ] Statistical analysis This study is a randomized controlled trial. The primary outcome measure was the incidence of significant atelectasis following interventional treatment for vascular malformations in children. According to our preliminary research results, among children undergoing interventional treatment for vascular malformations, the incidence of atelectasis at the end of surgery was 90% in the mask oxygenation group, 94% in the endotracheal intubation group, and 63% in the HFNC group. We hypothesized that the incidence of postoperative atelectasis in Group H would be 30% lower. With a two-sided α set at 0.05 and a β at 0.10, PASS software version 15 calculated a sample size of 24 patients per group to achieve the maximum sample size. Considering a 15% dropout rate, 28 patients were needed for each; thus, a total of 84 patients were needed. Data analysis was conducted using SPSS 26.0 statistical software. Normally distributed measurement data are expressed as the mean ± standard deviation ( ± s), and comparisons between groups were made via one-way ANOVA, with pairwise comparisons corrected with the Bonferroni method. Repeated-measures ANOVA was used for within-group comparisons. Nonnormally distributed data are expressed as the median (M) and interquartile range (IQR) and were compared between groups via the Kruskal‒Wallis H test, with pairwise comparisons corrected with the Bonferroni method. Count data are expressed as a percentage (%) and were compared via the chi-square test. A P value < 0.05 indicated statistical significance. RESULT Eighty-one pediatric patients who met the inclusion criteria were randomly assigned to Group M, Group T, or Group H in this study. However, one patient in Group M was excluded because her SpO 2 was less than 92% for more than five minutes and she needed endotracheal intubation during surgery, so a total of 80 patients were ultimately included (Fig. 3 ). There were no statistically significant differences among the three groups in terms of age, sex, BMI, ASA classification, location of the vascular malformation, duration of surgery, or the dosages of propofol and fentanyl ( P > 0.05) (Table 1 ). Table 1 Comparison of general information, operation duration, and medication dosage among three groups of patients M group(n = 26) T group(n = 27) H group(n = 27) P Age (years) 3.5 ± 1.56 3.41 ± 1.53 3.44 ± 1.40 0.947 Gender (Male/Female) 15/11 17/10 14/13 0.719 BMI (kg/m2 ) 15.73 ± 1.86 16.29 ± 1.20 15.46 ± 1.30 0.152 ASA(I/II) 24/2 25/2 26/1 0.867 Operation duration (min) 30.73 ± 3.08 31.00 ± 3.31 31.07 ± 2.85 0.914 Propofol dosage (mg) 119.74 ± 22.85 121.31 ± 26.42 119.53 ± 24.91 0.959 Fentanyl dosage (µg) 58.92 ± 10.15 59.41 ± 12.14 58.37 ± 11.16 0.944 Deformed area (n, %) 0.836 Neck and head 9(34.6%) 8(29.6%) 7(25.9%) Limbs 13(50.0%) 12(44.4%) 15(55.6%) Trunk 4(15.4%) 7(25.9%) 5(18.5%) Note . Values are presented as the mean ± standard deviation, number (percentage). BMI = body mass index, ASA = the American Society of Anesthesiologists physical status. At T 0 , there was no statistically significant difference in the baseline B-line scores or subpleural consolidation scores among the three groups of children ( P > 0.05) (Table 2 ). Compared with Group H, Groups M and T had significantly higher B-line scores, subpleural consolidation scores, and incidences of atelectasis at T 1 and T 2 ( P < 0.05). Compared with those at T 0 , the B-line scores and subpleural consolidation scores at T 1 and T 2 were significantly greater in all three groups ( P < 0.05). Table 2 Comparison of B-line score, subpleural consolidation score, and incidence of significant atelectasis among three groups of patients M group (n = 26) T group (n = 27) H group (n = 27) P Before anesthesia induction (T0) Line B score 0(0,0) 0(0,0) 0(0,0) 1.000 Subpleural consolidation score 0(0,0) 0(0,0) 0(0,0) 1.000 At the end of the surgery (T1) Line B score 10(8.75,11) ab 9(8,10) ab 4(2,6) a <0.001 Subpleural consolidation score 10.5(10,12) ab 10(8,12) ab 5(3,6) a <0.001 Significant atelectasis 25(96.0%) b 27(100%) b 23(85.0%) 0.066 Upon exiting PACU (T2) Line B rating 7(6,7) ab 5(4,6) ab 3(1,4) a <0.001 Subpleural consolidation score 8(6,8.25) ab 5(4,7) ab 3(2,4) a <0.001 Significant atelectasis 24(92.3%) b 24(88.9%) b 17(63.0%) 0.011 Note. Data is presented as M and IQR or number (percentage), Group differences were compared using the Kruskal-Wallis H test or Chi-squared test, and pairwise comparisons were conducted using Bonferroni correction. P < 0.05 indicates statistical significance. a P < 0.05 compared to T 0 ; b P < 0.05 (considering Bonferroni correction)compared to HFNC gruop. At T 1, both Group M and Group H had significantly greater PaCO 2 values and lower pH values (P < 0.05) than Group T did (Table 3 ). At T 1, both Group T and Group H had significantly greater PaO 2 values (P < 0.05) than Group M did, and at T 3 , Group H had significantly lower pH values than Group M did (P < 0.05). Compared with T0, at T1, all the groups (Group M, Group T, and Group H) had significantly greater PaO 2 values (P < 0.05), Group M and Group H had significantly greater PaCO 2 values (P < 0.05), and Group M and Group H had significantly lower pH values (P < 0.05). Table 3 Comparison of PaO2, PaCO2, and PH among three groups of patients M group (n = 26) T group (n = 27) H group (n = 27) P Before anesthesia induction (T0) PaO 2 (mmHg) 98.73 ± 1.19 98.96 ± 1.19 98.85 ± 1.17 0.775 PaCO 2 (mmHg) 39.61 ± 1.83 39.52 ± 1.92 39.04 ± 1.56 0.449 PH 7.39 ± 0.018 7.39 ± 0.017 7.39 ± 0.015 0.610 At the end of the surgery (T1) PaO 2 (mmHg) 268.23 ± 92.75 a 346.81 ± 89.87 ac 373.48 ± 96.67 ac <0.001 PaCO 2 (mmHg) 48.69 ± 5.13 ab 40.93 ± 3.68 51.07 ± 6.86 ab <0.001 PH 7.31 ± 0.053 ab 7.39 ± 0.035 7.28 ± 0.047 abc <0.001 Note. Values are presented as the mean ± standard deviation, Group differences were compared using one-way ANOVA, and pairwise comparisons were conducted using Bonferroni correction. a P < 0.05 compared to T 0 ; b P < 0.050 (considering Bonferroni correction) compared to T grop; c P < 0.050 (considering Bonferroni correction) compared to M grop. Compared with those in Group T, the awakening time, PAED score, incidence of postoperative agitation, and incidence of postoperative nausea and vomiting in Group M and Group H were significantly lower ( P < 0.05), and there were no cases of reflux aspiration (Table 4 ). Table 4 Comparison of Awakening Time, PAED Score, and Peri-anesthetic Adverse Reactions Among Three Groups of Patients M group (n = 26) T group (n = 27) H group (n = 27) P Awakening time (min) 13(12, 13) a 18(16, 19) 14(13, 15) a <0.001 PAED score 6(5, 7.25) a 9(8, 11) 5(4, 7) a <0.001 Postoperative agitation (n, %) 3(11.5%) a 9(33.3%) 2(7.40%) a 0.027 SpO2 < 92% (n, %) Nausea, vomiting (n, %) 4(15.4%) 2(7.40%) 2(7.40%) 0.528 Hoarseness (n, %) 0(0.00%) a 5(18.5%) 1(3.70%) a 0.043 Aspiration of reflux (n, %) 1(3.80%) 6(22.0%) 2(7.45%) 0.121 body movement (n, %) 0(0.00%) 0(0.00%) 0(0.00%) 1.000 Note. Data is presented as M and IQR or number (percentage), Group differences were compared using the Kruskal-Wallis H test or Chi-squared test, and pairwise comparisons were conducted using Bonferroni correction. P < 0.05 indicates statistical significance. a P < 0.050 (considering Bonferroni correction) compared to T group. For the three groups of children, the classifications for PPCs within 7 days were as follows: Group M had 23 cases (88.5%) of Grade 0 and 3 cases (11.5%) of Grade 1; Group T had 20 cases (74.1%) of Grade 0, 6 cases (22.2%) of Grade 1, and 1 case (3.70%) of Grade 3; and Group H had 25 cases (92.6%) of Grade 0 and 2 cases (7.40%) of Grade 1. There was no statistically significant difference in the classification of PPCs within 7 days among the three groups of children (Table 5 ). Table 5 Comparison of PPCs classification among three groups within seven days PPCs Classification M group (n = 26) T group (n = 27) H group (n = 27) P Level 0 23(88.5%) 20(74.1%) 25(92.6%) 0.185 Level 1 3(11.5%) 6(22.2%) 2(7.40%) 0.306 Level 2 0(0.00%) 1(3.70%) 0(0.00%) 1.000 Level 3 0(0.00%) 0(0.00%) 0(0.00%) 1.000 Level 4 0(0.00%) 0(0.00%) 0(0.00%) 1.000 Note . Data is presented as number (percentage). Group differences were compared using the Chi-squared test. PPCS = Postoperative pulmonary complications. DISCUSSION In this study, we investigated the effect of HFNC oxygen therapy on postoperative lung ultrasound scores and the incidence of significant postoperative atelectasis in healthy children undergoing interventional treatment for vascular malformations. The main findings of this study indicate that, compared with those in the mask oxygenation group and the endotracheal intubation group, the postoperative B-line scores, subpleural consolidation scores, and incidence of significant postoperative atelectasis were significantly lower in the HFNC group ( P < 0.05). VMs are lesions of the vascular or lymphatic system that are often considered caused by dysplasia of the vascular morphology and commonly occur in the head and neck or limbs. [ 20 ] Owing to the functional and morphological abnormalities that VMs can cause in affected blood vessels, the clinical course and range of symptoms are often unpredictable, thus surgical intervention is often needed for treatment. [ 2 ] For vascular malformation, interventional therapy involves injection of sclerosing agents or other drugs into the affected blood vessels under the guidance of medical imaging equipment, thereby inducing inflammation and causing the diseased blood vessels to harden and narrow. [ 21 ] Currently, the ventilation methods commonly used for this type of surgery include endotracheal intubation and mask oxygenation, but because pediatric patients have unique physiological characteristics, they are more prone to atelectasis after surgery under general anesthesia. [ 3 ] This study revealed that after endotracheal intubation and mask oxygenation, the incidence of postoperative atelectasis in pediatric patients can be as high as 92.3% and 88.9%. HFNC is a noninvasive oxygen therapy method that has been widely applied in short surgeries performed under general anesthesia. [ 10 ] It delivers oxygen through a dedicated nasal cannula at a flow rate exceeding the patient's minute ventilation, thereby creating positive pressure in the upper airway to maintain alveolar patency. [ 9 ] Studies revealed that HFNC oxygen therapy ensures an adequate positive end-expiratory pressure by delivering oxygen at a rate of 35 L/min, resulting in a nasopharyngeal airway pressure of 2.7 cmH 2 O and increased lung capacity in adult patients with closed mouths. Moreover, in premature infants, a high-flow rate of 2 L/kg/min can result in a nasopharyngeal pressure > 2.62 cmH 2 O. [ 23 ] SHIH et al. [ 24 ] found that HFNC oxygen therapy can maintain PEEP in spontaneously breathing patients by providing continuous positive airway pressure, effectively avoiding postoperative atelectasis in adult patients. In addition, during HFNC oxygen therapy, the oxygen is maintained at a constant temperature and humidity, thus improving ciliary mucosal function, promoting secretion clearance, preventing airway obstruction, and preventing atelectasis. [ 25 ] This study revealed that HFNC oxygen therapy can significantly reduce the LUS at the end of surgery and discharge from the PACU as well as reduce the incidence of postoperative atelectasis to 63% in children undergoing interventional treatment for vascular malformations. The findings presented here are similar to those of previous research. [ 13 ] However, we found that HFNC oxygen therapy cannot completely prevent postoperative atelectasis in children, possibly because a HFNC delivers a high concentration of oxygen. Moreover, HFNC oxygen therapy may increase the absorption of residual gas in the alveoli, leading to alveolar collapse and therefore a reduced respiratory rate in children under anesthesia and possibly atelectasis. [ 26 ] HFNC oxygen therapy can effectively improve oxygenation, extend the time of deoxygenation, and effectively prevent the occurrence of hypoxemia. [ 27 , 28 ] LIN et al. [ 27 ] conducted a large-scale randomized controlled trial and reported that in 1994 patients who underwent painless gastroscopy, HFNC oxygen therapy effectively prevented the occurrence of hypoxia during the procedure. Moreover, previous studies revealed that the use of a HFNC during sedation can reduce the need for tracheal intubation in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, thus reducing the risk associated with invasive airway procedures. [ 29 ] In this study, we observed that group H had a higher PaO 2 value at the end of surgery than group M did, however, there was no statistically significant difference in the incidence of hypoxemia (SpO2 < 92%) among the three groups of children. This may be because only children with healthy lungs before surgery were included in our study, thus potentially decreasing the benefit of HFNC oxygen therapy in this regard. HERMEZ et al. [ 30 ] reported that, compared with conventional oxygen therapy, HFNC oxygen therapy can improve CO 2 clearance as a result of the combined effect of supraglottic gas vortices and strong turbulence generated by high-flow gas delivery and cardiogenic oscillations. Although we found that the PaCO 2 values of group M (48.69 mmHg) and group H (51.07 mmHg) were significantly greater than that of group T (40.93 mmHg) at the end of surgery, they were still within the safe range. This finding indicates that HFNC oxygen therapy can be safely administered to pediatric patients undergoing interventional treatment for vascular malformation, but it is still necessary to monitor the patient's PaCO 2 during the operation to avoid possible CO 2 accumulation and severe hypercapnia over time. [ 31 ] In addition, heated and humidified gas can be delivered via a HFNC, effectively improving the patient comfort during oxygen therapy [ 32 ] . Our study revealed that, compared with group T, group H had a shorter recovery time; a lower incidence of postoperative restlessness, nausea, and vomiting; and no increased risk of other adverse reactions. This study has several limitations. First, this was a single-center, small-sample study, and patients known to have difficult airways and abnormal preoperative lung function were excluded. Multicenter, large-sample studies are urgently needed for further confirmation of the findings presented here. Second, HFNC oxygen therapy can increase airway pressure during closed-mouth breathing. Although each child underwent a comprehensive examination, some still breathed with their mouths open during the interventional procedure, which may have led to the inability to maintain the positive airway pressure promoted by HFNC oxygen therapy. CONCLUSION In summary, HFNC oxygen therapy during DSA-guided interventional treatment for vascular malformations can reduce the postoperative LUS and decrease the incidence of postoperative atelectasis in children, as it ensures adequate oxygenation during surgery under general anesthesia, and reduces the risks of emergence agitation and nausea and vomiting potentially caused by endotracheal intubation without promoting excessive CO 2 accumulation or increasing the risk of other adverse reactions. Whether intraoperative HFNC oxygen therapy reduces the risk of long-term postoperative pulmonary complications in children at high risk for postoperative pulmonary complications requires further investigation. Abbreviations VMs vascular malformations HFNC High - Flow Nasal Cannula PPCs Postoperative Pulmonary Complications PEEP Positive End - Expiratory Pressure ASA American Society of Anesthesiologists BMI Body Mass Index PAED Pediatric Anesthesia Emergence Delirium LUS Lung Ultrasound ABG Aarterial blood gas analysis ANOVA Analysis of variance Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Ethical approval was obtained from the Research Ethics Committee of the first affiliated of Gannan Medical University (reference number: LLSC-2023486) on November 28, 2023. The trial was registered online on December 14 2023 in the Chinese Clinical Trial Registry (ChiCTR2300078634, https://www.chictr.org.cn), and the first patient was enrolled on January 3, 2024. Written informed consent was obtained from all participants in this study. Consent for publication Not applicable. Availability of data and materials The data cannot be fully disclosed due to privacy, ethical or other reasons. If necessary, one can apply to the Ethics Committee of the First Affiliated Hospital of Gannan Medical University, or contact the authors and meet certain cooperation conditions. Competing of interests The authors declare that they have no competing interests. Funding No external funds were received to support this study. Authors' contributions MZF contributed to writing the original draft, reviewing and editing, conceptualization, visualization, methodology, project administration, formal analysis, and investigation. ZM and WLF participated in investigation, writing review and editing, data curation, and resources. HR ZLF and LH was responsible for data curation, formal analysis, investigation, visualization, and software. 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Ultrasound Assessment of Antibiotic-Induced Pulmonary Reaeration in Ventilator-Associated Pneumonia[J]. Crit Care Med. 2010;38(1):84–92. JIANG Z, LIU S, WANG L, et al. Effects of 30% vs. 60% Inspired Oxygen Fraction during Mechanical Ventilation on Postoperative Atelectasis: A Randomised Controlled Trial[J]. BMC Anesthesiol. 2023;23(1):265. RESTREPO RD. Current Challenges in the Recognition, Prevention and Treatment of Perioperative Pulmonary Atelectasis[J]. Expert Rev Respir Med. 2015;9(1):97–107. DUGGAN M, KAVANAGH BP. Pulmonary Atelectasis: A Pathogenic Perioperative Entity[J]. Anesthesiology. 2005;102(4):838–54. SREENAN C, LEMKE R P, HUDSON-MASON A, et al. High-Flow Nasal Cannulae in the Management of Apnea of Prematurity: A Comparison With Conventional Nasal Continuous Positive Airway Pressure[J]. Pediatrics. 2001;107(5):1081–3. HELVIZ Y. A Systematic Review of the High-Flow Nasal Cannula for Adult Patients[J]. Crit Care. 2018;22(1):71. LEE, J-H, JI S-H, JANG Y-E, et al. Application of a High-Flow Nasal Cannula for Prevention of Postextubation Atelectasis in Children Undergoing Surgery: A Randomized Controlled Trial[J]. Anesth Analg. 2021;133(2):474–82. SHIOJI N, IWASAKI T, KANAZAWA T, et al. Physiological Impact of High-Flow Nasal Cannula Therapy on Postextubation Acute Respiratory Failure after Pediatric Cardiac Surgery: A Prospective Observational Study[J]. J Intensive Care. 2017;5:35. RONCIN C, SCEMAMA U. Atelectasis Prevention during Anaesthesia Using High-Flow Nasal Cannula Therapy: A Paediatric Randomised Trial Using MRI Images[J]. Anaesth Crit Care Pain Med. 2020;39(6):819–24. X Y, Z Z. Y Z, Performance of Lung Ultrasound in Detecting Peri-Operative Atelectasis after General Anesthesia[J/OL]. Ultrasound Med Biol, 2016, 42(12)[2025-02-10]. https://pubmed.ncbi.nlm.nih.gov/27639431/ REN Y, LIU J, NIE X, et al. Association of Tidal Volume during Mechanical Ventilation with Postoperative Pulmonary Complications in Pediatric Patients Undergoing Major Scoliosis Surgery[J]. Paediatr Anaesth. 2020;30(7):806–13. HUMPHREYS S, LEE-ARCHER P, REYNE G, et al. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) in Children: A Randomized Controlled Trial[J]. Br J Anaesth. 2017;118(2):232–8. ACOSTA C M, MAIDANA G A, JACOVITTI D, et al. Accuracy of Transthoracic Lung Ultrasound for Diagnosing Anesthesia-Induced Atelectasis in Children[J]. Anesthesiology. 2014;120(6):1370–9. SONG I-K, KIM E-H, LEE J-H, et al. Effects of an Alveolar Recruitment Manoeuvre Guided by Lung Ultrasound on Anaesthesia-Induced Atelectasis in Infants: A Randomised, Controlled Trial[J]. Anaesthesia. 2017;72(2):214–22. PARK S, LEE J H, KIM HJ, et al. Optimal Positive End-Expiratory Pressure to Prevent Anaesthesia-Induced Atelectasis in Infants: A Prospective, Randomised, Double-Blind Trial[J]. Eur J Anaesthesiol. 2021;38(10):1019–25. WASSEF M, BLEI F. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies[J]. Pediatrics. 2015;136(1):e203–214. RANJITHA Y S ZADKARS, MISHRA P, et al. High-Flow Nasal Cannula (HFNC) Oxygenation for Sclerotherapy of Facial and Upper Airway Vascular Malformations in Pediatric Patients: Case Series[J]. J Anaesthesiol Clin Pharmacol. 2023;39(2):309–12. PARKE R, MCGUINNESS S. Nasal High-Flow Therapy Delivers Low Level Positive Airway Pressure[J]. Br J Anaesth. 2009;103(6):886–90. CORLEY A, CARUANA L R, BARNETT A G, et al. Oxygen Delivery through High-Flow Nasal Cannulae Increase End-Expiratory Lung Volume and Reduce Respiratory Rate in Post-Cardiac Surgical Patients[J]. Br J Anaesth. 2011;107(6):998–1004. SHIH C-C, LIANG P-C, CHUANG Y-H, et al. Effects of High-Flow Nasal Oxygen during Prolonged Deep Sedation on Postprocedural Atelectasis: A Randomised Controlled Trial[J]. Eur J Anaesthesiol. 2020;37(11):1025–31. M N. High-Flow Nasal Cannula Oxygen Therapy in Adults[J/OL]. J Intensive Care, 2015, 3(1)[2024-11-26]. https://pubmed.ncbi.nlm.nih.gov/25866645/ MISHIMA G, SANUKI T, REVIE J, et al. Nasal High Flow Improves Ventilation during Propofol Sedation: A Randomized Cross-over Study in Healthy Volunteers[J]. Respir Physiol Neurobiol. 2020;277:103429. LIN Y, ZHANG X, LI L, et al. High-Flow Nasal Cannula Oxygen Therapy and Hypoxia during Gastroscopy with Propofol Sedation: A Randomized Multicenter Clinical Trial[J]. Gastrointest Endosc. 2019;90(4):591–601. LA COMBE B, MESSIKA J. Increased Use of High-Flow Nasal Oxygen during Bronchoscopy[J]. Eur Respir J. 2016;48(2):590–2. SCHUMANN R, NATOV N S, ROCUTS-MARTINEZ K A, et al. High-Flow Nasal Oxygen Availability for Sedation Decreases the Use of General Anesthesia during Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound[J]. World J Gastroenterol. 2016;22(47):10398–405. HERMEZ L A, SPENCE C J, PAYTON M J, et al. A Physiological Study to Determine the Mechanism of Carbon Dioxide Clearance during Apnoea When Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)[J]. Anaesthesia. 2019;74(4):441–9. GUSTAFSSON I-M, LODENIUS Å, TUNELLI J, et al. Apnoeic Oxygenation in Adults under General Anaesthesia Using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) - a Physiological Study[J]. Br J Anaesth. 2017;118(4):610–7. CUQUEMELLE E, PHAM T, PAPON J-F, et al. Heated and Humidified High-Flow Oxygen Therapy Reduces Discomfort during Hypoxemic Respiratory Failure[J]. Respir Care. 2012;57(10):1571–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 Jul, 2025 Read the published version in BMC Anesthesiology → Version 1 posted Editorial decision: Revision requested 19 May, 2025 Reviews received at journal 15 May, 2025 Reviews received at journal 13 May, 2025 Reviewers agreed at journal 12 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviewers agreed at journal 08 May, 2025 Reviews received at journal 08 May, 2025 Reviewers agreed at journal 28 Apr, 2025 Reviewers invited by journal 28 Apr, 2025 Editor assigned by journal 28 Apr, 2025 Editor invited by journal 24 Apr, 2025 Submission checks completed at journal 23 Apr, 2025 First submitted to journal 23 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6452369","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":449359335,"identity":"22fc8ba5-4a57-45be-a531-8c1048518ade","order_by":0,"name":"Mai Zifeng","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Mai","middleName":"","lastName":"Zifeng","suffix":""},{"id":449359336,"identity":"d3170236-80dc-4524-9c27-3810ff95066b","order_by":1,"name":"Zhuo Ming","email":"","orcid":"","institution":"The First Affiliated Hospital of Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhuo","middleName":"","lastName":"Ming","suffix":""},{"id":449359337,"identity":"e1eaa669-d646-4447-a22c-437a0d9e57e8","order_by":2,"name":"Zhang Longfei","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhang","middleName":"","lastName":"Longfei","suffix":""},{"id":449359338,"identity":"9497433c-2421-46f4-8274-9196d38297f6","order_by":3,"name":"Luo Hao","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Luo","middleName":"","lastName":"Hao","suffix":""},{"id":449359339,"identity":"d7a2954a-a6a4-4422-85a5-5ce46fc84c83","order_by":4,"name":"Han Rui","email":"","orcid":"","institution":"Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Han","middleName":"","lastName":"Rui","suffix":""},{"id":449359340,"identity":"6c2f3956-08be-40ed-80be-6e5741ea9d59","order_by":5,"name":"Wang Lifeng","email":"","orcid":"","institution":"The First Affiliated Hospital of Gannan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Lifeng","suffix":""},{"id":449359341,"identity":"cad46a7c-a067-4b57-8283-b7bd246400e9","order_by":6,"name":"Zhong Maolin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYFAC5sYHHwxs5NjY2w8Qq4Wx2XBGRZoxH8+ZBKK1tEnznDmcOE/CwYA4DfLTDjYbzmxjTm+TYEhg+FGxjQg7Zic2PvjYxpbbJt14gLHnzG3CWpilE0G28OS2yRxIYGZsI0ILm3RimzRvm0Q6m0SCAXFaeEBaeM4YJBCvRQLksBkVCYZtwEA+SJRf5GcnHwRG5X95+fb2gw9+VBChBQUcIFH9KBgFo2AUjAJcAACOeDweqpT3bgAAAABJRU5ErkJggg==","orcid":"","institution":"Anesthesia Key Laboratory of Gannan Medical University","correspondingAuthor":true,"prefix":"","firstName":"Zhong","middleName":"","lastName":"Maolin","suffix":""}],"badges":[],"createdAt":"2025-04-15 08:08:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6452369/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6452369/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12871-025-03192-x","type":"published","date":"2025-07-01T15:57:15+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":82143821,"identity":"22283ce0-50b2-44c3-96a7-e9d422f36a08","added_by":"auto","created_at":"2025-05-07 06:42:55","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":249543,"visible":true,"origin":"","legend":"\u003cp\u003eDivision of the chest into segments for lung ultrasound examination, described by Acosta et al. \u003csup\u003e[17]\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6452369/v1/c2b8d91477a06db5a731457f.png"},{"id":82141597,"identity":"d725f01e-e3f0-44b2-99da-fc4da50191f3","added_by":"auto","created_at":"2025-05-07 06:34:55","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":320220,"visible":true,"origin":"","legend":"\u003cp\u003eThe degree of C (asterisks) and B (arrows), described by Song et al.\u003csup\u003e[18]\u003c/sup\u003e B indicates B-lines; B0, fewer than 3 isolated B-lines; B1, multiple well-defined B-lines; B2, multiple coalescent B-lines; B3, white lung; C, consolidation; C0, no consolidation; C1, minimal juxtapleural consolidation; C2, small-sized consolidation; C3, large sized consolidation.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6452369/v1/761ac7283294b103c1bb3070.png"},{"id":82141599,"identity":"672517b9-b0c5-48ae-bb36-437e8c849b94","added_by":"auto","created_at":"2025-05-07 06:34:55","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":261817,"visible":true,"origin":"","legend":"\u003cp\u003eConsolidation standards of the reporting trials statement.\u003c/p\u003e\n\u003cp\u003eHFNC = High-flow nasal cannula.\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-6452369/v1/b9eb573a8b9d1560afa2854a.png"},{"id":86178944,"identity":"7cf1f81a-98cd-40bc-ab8d-8c972078af6c","added_by":"auto","created_at":"2025-07-07 16:12:11","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1833698,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6452369/v1/ff1c4ae7-8fa4-41b2-ba7e-982d30789e18.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of High-Flow Nasal Cannula Oxygen Therapy On The Postoperative Atelectasis in Interventional Sclerotherapy: A Randomized Controlled Trial","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eInterventional sclerotherapy under digital subtraction angiography guidance has become an important treatment method for vascular malformations.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e Further more, since pediatric patients typically require general anesthesia for such surgeries, the incidence of atelectasis after tracheal intubation under general anesthesia can be as high as 68\u0026ndash;100% owing to the low functional residual capacity in children.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e Studies have revealed that, in children, perioperative atelectasis negatively affects oxygenation \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e and increases the risk of postoperative pulmonary complications (PPCs), such as pneumonia and acute lung injury, thus prolonging the recovery time.\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e Thus, better ventilation strategies that can be used under general anesthesia are needed to reduce the incidence of perioperative atelectasis and decrease the risk of PPCs.\u003c/p\u003e \u003cp\u003eIn recent years, HFNC oxygen therapy has attracted attention because of its ability to create positive pressure in the airway by delivering a high concentration of heated and humidified oxygen continuously.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e Researchers reported that HFNC therapy is frequently used in anesthesia for short procedures\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e and that it improves respiratory function in children by increasing oxygenation and therefore reduces the incidence of perioperative atelectasis.\u003csup\u003e[\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e However, there is a lack of relevant research on the application of HFNC oxygen therapy in pediatric interventional treatment for vascular malformations.\u003c/p\u003e \u003cp\u003eDuring pediatric surgery under anesthesia, although the HFNC delivers PEEP, which in turn improves oxygenation, its effectiveness for preventing atelectasis during surgery remains unclear. In pediatric patients with vascular malformations undergoing interventional sclerotherapy under general anesthesia, significant atelectasis, which can be detected via LUS.\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e Therefore, the aims of our study were to explore the potential of HFNC oxygen therapy for reducing the incidence of atelectasis.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and patient recruitment\u003c/h2\u003e \u003cp\u003eThe study was conducted in the Department of Anesthesiology of the First Affiliated Hospital of Gannan Medical University from January 2024 to December 2024. Pediatric patients aged between 1 and 6 years, with an American Society of Anesthesiologists (ASA) physical status classification I-II, a body mass index (BMI) less than 19.8 kg/m\u0026sup2;, who underwent DSA-guided interventional sclerotherapy for VM and provided written informed consent were included in the study. The exclusion criteria were as follows: refusal by the child or their family; nasal anatomical abnormalities; a history of thoracic surgery; severe cardiac, pulmonary, hepatic, or renal disease; and a preoperative LUS score\u0026thinsp;\u0026gt;\u0026thinsp;2. The additional exclusion criteria were: changes to the anesthesia method or surgical plan for any reason, or the inability to cooperate with the lung ultrasound examination.\u003c/p\u003e \u003cp\u003eFor this randomized, prospective, controlled study, 80 pediatric patients were recruited and randomly assigned to three groups: Group M, Group T, and Group H. The random number generator in SPSS 25.0 software was used. A fixed random number seed of 20240101 was set, and then the random function was used to generate random numbers for each patient. The SPSS visual binning function was then used to randomly assign the patients to the respective groups. The anesthesiologists were handed sealed envelopes containing the group information and selected the corresponding anesthesia method for ventilation and surgery. Professionally-trained anesthesiologists calculated the LUS, and neither the anesthesiologist who was responsible for calculating the LUS nor the parents/guardians were aware of the group information. The primary outcome was the incidence of significant atelectasis at T\u003csub\u003e1\u003c/sub\u003e and T\u003csub\u003e2\u003c/sub\u003e. The secondary outcomes included the LUS at T\u003csub\u003e0\u003c/sub\u003e, T\u003csub\u003e1\u003c/sub\u003e, and T\u003csub\u003e2\u003c/sub\u003e; the results of the arterial blood gas analysis (ABGA) at T0 and T1; the incidence of intraoperative and postoperative hypoxemia (SpO\u003csub\u003e2\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;92%); the Pediatric Anesthesia Emergence Delirium (PAED) score during the stay in the PACU; the incidence of emergence agitation (a PAED score\u0026thinsp;\u0026gt;\u0026thinsp;10); the postoperative awakening time (the time from the discontinuation of medication administration to the time of first eye opening or crying); the incidence of perioperative adverse reactions (such as aspiration, hoarseness, nausea, and vomiting); and the severity of pulmonary complications within seven days after surgery (grades 0\u0026ndash;4). Grade 0 represents no PPCs; grade 1 indicates dry cough, minor atelectasis accompanied by fever and difficulty breathing, etc.; grade 2 indicates cough, hypoxemia, severe atelectasis accompanied by fever, etc.; grade 3 indicates pleural effusion, pneumonia, and the need for reintubation after surgery; and grade 4 indicates respiratory failure.\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e If SpO\u003csub\u003e2\u003c/sub\u003e falls below 92% perioperatively, we use the chin lift method to ensure ventilation. If SpO\u003csub\u003e2\u003c/sub\u003e continues to decrease or remains below this threshold for more than 5 minutes, we perform endotracheal intubation and exclude the patient from the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eAnesthesia methods\u003c/h3\u003e\n\u003cp\u003e The parents of the children included in the study signed informed consent forms before surgery. No food or fluid intake was allowed prior to surgery (solid food for 8 hours, milk for 6 hours, breast milk for 4 hours, or water for 2 hours). Intravenous access was established before surgery. Each patient\u0026rsquo;s ECG, SpO\u003csub\u003e2\u003c/sub\u003e, and MAP were monitored shortly after arriving at the operating room. In Group M, 4 \u0026micro;g/kg fentanyl and 2.5\u0026thinsp;~\u0026thinsp;4 mg/kg propofol were slowly injected in sequence, and the patient's eyelash reflex disappeared with a fixed mask. Ventilation was set at 10 L/min. In Group T, 4 \u0026micro;g/kg fentanyl and 2.5\u0026thinsp;~\u0026thinsp;4 mg/kg propofol were slowly injected in sequence, and after the patient's eyelash reflex disappeared, 0.6 mg/kg rocuronium bromide was slowly injected. Tracheal intubation was performed 2 minutes later, and after the tube was confirmed to be in the appropriate position via auscultation, it was fixed. The settings were as follows: VT 8 ml/kg, I/E\u0026thinsp;=\u0026thinsp;1:2, and the respiratory rate was adjusted to maintain the P\u003csub\u003eET\u003c/sub\u003eCO\u003csub\u003e2\u003c/sub\u003e at 35\u0026thinsp;~\u0026thinsp;45 mmHg. In Group H, 4 \u0026micro;g/kg fentanyl and 2.5\u0026thinsp;~\u0026thinsp;4 mg/kg propofol were slowly injected in sequence, and after the patient's eyelash reflex disappeared, a dedicated HFNC nasal cannula was fixed. Oxygen was administered according to the patient's weight (5\u0026thinsp;~\u0026thinsp;15 kg, 2 L/kg/min; 15\u0026thinsp;~\u0026thinsp;30 kg, 35 L/min)\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. All three groups were ventilated with pure oxygen. After surgery, the patient was transferred to the postanesthesia care unit. After the patients in Groups T, H, and M were extubated upon arrival to the postanesthesia care unit, nasal oxygen therapy was started. No antagonists were used during the recovery period, and the patient was sent back to the ward when the Steward score was \u0026ge;\u0026thinsp;4. If the patient had significant body movements during surgery, 2 mg/kg propofol was administered intravenously; if the patient\u0026rsquo;s SpO\u003csub\u003e2\u003c/sub\u003e fell below 92%, mask-assisted ventilation was given; if the patient\u0026rsquo;s HR fell below 80 beats per minute, 0.01 mg/kg atropine was administered intravenously.\u003c/p\u003e\n\u003ch3\u003eLung ultrasonography\u003c/h3\u003e\n\u003cp\u003eLung ultrasound examinations were conducted at three time points: T\u003csub\u003e0\u003c/sub\u003e, T\u003csub\u003e1\u003c/sub\u003e, and T\u003csub\u003e2\u003c/sub\u003e. An anesthesiologist with extensive experience in lung ultrasound examinations used an M-7 ultrasound system (Mindray, Shenzhen, China) equipped with a high-frequency linear array transducer (8\u0026ndash;12 MHz) to longitudinally scan the patient from the caudal to the cephalic direction.\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e The patients were examined in the supine or lateral decubitus position according to the twelve-zone method. The thorax was divided into two hemithoraces by two short-axis lines (one line above the diaphragm plane and the other line 1 cm above the line connecting the two nipples), and each hemithorax was further divided into six regions by three long-axis lines (the anterior midline, the left and right anterior axillary lines, and the left and right posterior axillary lines). During the examination, the probe was kept parallel to the ribs, and the severity of pleural consolidation was scored from 0 to 3 (0 indicating normal pleura without consolidation; 1 indicating small areas of consolidation beneath the pleura; 2 indicating moderate areas of consolidation beneath the pleura; 3 indicating large areas of consolidation beneath the pleura) [18]; the B-line score ranged from 0 to 3 (0 indicating A-lines, isolated B-lines less than 3; 1 indicating isolated B-lines more than 3; 2 indicating coalescent B-lines; 3 indicating white lung).\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e Significant atelectasis was defined as a pleural consolidation score\u0026thinsp;\u0026ge;\u0026thinsp;2 in any region.\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThis study is a randomized controlled trial. The primary outcome measure was the incidence of significant atelectasis following interventional treatment for vascular malformations in children. According to our preliminary research results, among children undergoing interventional treatment for vascular malformations, the incidence of atelectasis at the end of surgery was 90% in the mask oxygenation group, 94% in the endotracheal intubation group, and 63% in the HFNC group. We hypothesized that the incidence of postoperative atelectasis in Group H would be 30% lower. With a two-sided α set at 0.05 and a β at 0.10, PASS software version 15 calculated a sample size of 24 patients per group to achieve the maximum sample size. Considering a 15% dropout rate, 28 patients were needed for each; thus, a total of 84 patients were needed.\u003c/p\u003e \u003cp\u003eData analysis was conducted using SPSS 26.0 statistical software. Normally distributed measurement data are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (\u003cspan class=\"InlineEquation\"\u003e\u003c/span\u003e\u0026plusmn;\u0026thinsp;s), and comparisons between groups were made via one-way ANOVA, with pairwise comparisons corrected with the Bonferroni method. Repeated-measures ANOVA was used for within-group comparisons. Nonnormally distributed data are expressed as the median (M) and interquartile range (IQR) and were compared between groups via the Kruskal‒Wallis H test, with pairwise comparisons corrected with the Bonferroni method. Count data are expressed as a percentage (%) and were compared via the chi-square test. A \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicated statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULT","content":"\u003cp\u003eEighty-one pediatric patients who met the inclusion criteria were randomly assigned to Group M, Group T, or Group H in this study. However, one patient in Group M was excluded because her SpO\u003csub\u003e2\u003c/sub\u003e was less than 92% for more than five minutes and she needed endotracheal intubation during surgery, so a total of 80 patients were ultimately included (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). There were no statistically significant differences among the three groups in terms of age, sex, BMI, ASA classification, location of the vascular malformation, duration of surgery, or the dosages of propofol and fentanyl (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of general information, operation duration, and medication dosage among three groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM group(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT group(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH group(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.5\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.41\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15/11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17/10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14/13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.719\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2 )\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.29\u0026thinsp;\u0026plusmn;\u0026thinsp;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.46\u0026thinsp;\u0026plusmn;\u0026thinsp;1.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eASA(I/II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25/2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26/1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.867\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation duration (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.73\u0026thinsp;\u0026plusmn;\u0026thinsp;3.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.00\u0026thinsp;\u0026plusmn;\u0026thinsp;3.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePropofol dosage (mg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e119.74\u0026thinsp;\u0026plusmn;\u0026thinsp;22.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121.31\u0026thinsp;\u0026plusmn;\u0026thinsp;26.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e119.53\u0026thinsp;\u0026plusmn;\u0026thinsp;24.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFentanyl dosage (\u0026micro;g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.92\u0026thinsp;\u0026plusmn;\u0026thinsp;10.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.41\u0026thinsp;\u0026plusmn;\u0026thinsp;12.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.37\u0026thinsp;\u0026plusmn;\u0026thinsp;11.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.944\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeformed area (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.836\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeck and head\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7(25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimbs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(50.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15(55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTrunk\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e. Values are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, number (percentage).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBMI\u0026thinsp;=\u0026thinsp;body mass index, ASA\u0026thinsp;=\u0026thinsp;the American Society of Anesthesiologists physical status.\u003c/p\u003e \u003cp\u003eAt T\u003csub\u003e0\u003c/sub\u003e, there was no statistically significant difference in the baseline B-line scores or subpleural consolidation scores among the three groups of children (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Compared with Group H, Groups M and T had significantly higher B-line scores, subpleural consolidation scores, and incidences of atelectasis at T\u003csub\u003e1\u003c/sub\u003e and T\u003csub\u003e2\u003c/sub\u003e (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared with those at T\u003csub\u003e0\u003c/sub\u003e, the B-line scores and subpleural consolidation scores at T\u003csub\u003e1\u003c/sub\u003e and T\u003csub\u003e2\u003c/sub\u003e were significantly greater in all three groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of B-line score, subpleural consolidation score, and incidence of significant atelectasis among three groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore anesthesia induction (T0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLine B score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubpleural consolidation score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0,0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt the end of the surgery (T1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLine B score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(8.75,11)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(8,10)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(2,6)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubpleural consolidation score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.5(10,12)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(8,12)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(3,6)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant atelectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25(96.0%)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27(100%)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(85.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpon exiting PACU (T2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLine B rating\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7(6,7)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4,6)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(1,4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubpleural consolidation score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(6,8.25)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(4,7)\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(2,4)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSignificant atelectasis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24(92.3%)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24(88.9%)\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17(63.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote.\u003c/b\u003e Data is presented as M and IQR or number (percentage), Group differences were compared using the Kruskal-Wallis H test or Chi-squared test, and pairwise comparisons were conducted using Bonferroni correction. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates statistical significance. \u003csup\u003ea\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05 compared to T\u003csub\u003e0\u003c/sub\u003e; \u003csup\u003eb\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05 (considering Bonferroni correction)compared to HFNC gruop.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAt T\u003csub\u003e1,\u003c/sub\u003e both Group M and Group H had significantly greater PaCO\u003csub\u003e2\u003c/sub\u003e values and lower pH values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) than Group T did (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). At T\u003csub\u003e1,\u003c/sub\u003e both Group T and Group H had significantly greater PaO\u003csub\u003e2\u003c/sub\u003e values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) than Group M did, and at T\u003csub\u003e3\u003c/sub\u003e, Group H had significantly lower pH values than Group M did (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Compared with T0, at T1, all the groups (Group M, Group T, and Group H) had significantly greater PaO\u003csub\u003e2\u003c/sub\u003e values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), Group M and Group H had significantly greater PaCO\u003csub\u003e2\u003c/sub\u003e values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and Group M and Group H had significantly lower pH values (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of PaO2, PaCO2, and PH among three groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBefore anesthesia induction (T0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98.73\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.96\u0026thinsp;\u0026plusmn;\u0026thinsp;1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98.85\u0026thinsp;\u0026plusmn;\u0026thinsp;1.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.775\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.015\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.610\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAt the end of the surgery (T1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e268.23\u0026thinsp;\u0026plusmn;\u0026thinsp;92.75\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e346.81\u0026thinsp;\u0026plusmn;\u0026thinsp;89.87\u003csup\u003eac\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e373.48\u0026thinsp;\u0026plusmn;\u0026thinsp;96.67\u003csup\u003eac\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaCO\u003csub\u003e2\u003c/sub\u003e (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48.69\u0026thinsp;\u0026plusmn;\u0026thinsp;5.13\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.86 \u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.31\u0026thinsp;\u0026plusmn;\u0026thinsp;0.053\u003csup\u003eab\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.28\u0026thinsp;\u0026plusmn;\u0026thinsp;0.047 \u003csup\u003eabc\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote.\u003c/b\u003e Values are presented as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, Group differences were compared using one-way ANOVA, and pairwise comparisons were conducted using Bonferroni correction. \u003csup\u003ea\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.05 compared to T\u003csub\u003e0\u003c/sub\u003e; \u003csup\u003eb\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.050 (considering Bonferroni correction) compared to T grop; \u003csup\u003ec\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.050 (considering Bonferroni correction) compared to M grop.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eCompared with those in Group T, the awakening time, PAED score, incidence of postoperative agitation, and incidence of postoperative nausea and vomiting in Group M and Group H were significantly lower (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and there were no cases of reflux aspiration (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Awakening Time, PAED Score, and Peri-anesthetic Adverse Reactions Among Three Groups of Patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwakening time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(12, 13)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18(16, 19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14(13, 15)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePAED score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(5, 7.25)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(8, 11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5(4, 7)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative agitation (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(11.5%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(7.40%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpO2\u0026thinsp;\u0026lt;\u0026thinsp;92% (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNausea, vomiting (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(7.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(7.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.528\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHoarseness (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(3.70%)\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAspiration of reflux (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(3.80%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6(22.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2(7.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ebody movement (n, %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote.\u003c/b\u003e Data is presented as M and IQR or number (percentage), Group differences were compared using the Kruskal-Wallis H test or Chi-squared test, and pairwise comparisons were conducted using Bonferroni correction. \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05 indicates statistical significance. \u003csup\u003ea\u003c/sup\u003e\u003cem\u003eP\u003c/em\u003e\u0026lt; 0.050 (considering Bonferroni correction) compared to T group.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eFor the three groups of children, the classifications for PPCs within 7 days were as follows: Group M had 23 cases (88.5%) of Grade 0 and 3 cases (11.5%) of Grade 1; Group T had 20 cases (74.1%) of Grade 0, 6 cases (22.2%) of Grade 1, and 1 case (3.70%) of Grade 3; and Group H had 25 cases (92.6%) of Grade 0 and 2 cases (7.40%) of Grade 1. There was no statistically significant difference in the classification of PPCs within 7 days among the three groups of children (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of PPCs classification among three groups within seven days\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPCs Classification\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eH group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e23(88.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20(74.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25(92.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2(7.40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1(3.70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLevel 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0(0.00%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e. Data is presented as number (percentage). Group differences were compared using the Chi-squared test.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePPCS\u0026thinsp;=\u0026thinsp;Postoperative pulmonary complications.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we investigated the effect of HFNC oxygen therapy on postoperative lung ultrasound scores and the incidence of significant postoperative atelectasis in healthy children undergoing interventional treatment for vascular malformations. The main findings of this study indicate that, compared with those in the mask oxygenation group and the endotracheal intubation group, the postoperative B-line scores, subpleural consolidation scores, and incidence of significant postoperative atelectasis were significantly lower in the HFNC group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003eVMs are lesions of the vascular or lymphatic system that are often considered caused by dysplasia of the vascular morphology and commonly occur in the head and neck or limbs.\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e Owing to the functional and morphological abnormalities that VMs can cause in affected blood vessels, the clinical course and range of symptoms are often unpredictable, thus surgical intervention is often needed for treatment.\u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e For vascular malformation, interventional therapy involves injection of sclerosing agents or other drugs into the affected blood vessels under the guidance of medical imaging equipment, thereby inducing inflammation and causing the diseased blood vessels to harden and narrow.\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e Currently, the ventilation methods commonly used for this type of surgery include endotracheal intubation and mask oxygenation, but because pediatric patients have unique physiological characteristics, they are more prone to atelectasis after surgery under general anesthesia.\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e This study revealed that after endotracheal intubation and mask oxygenation, the incidence of postoperative atelectasis in pediatric patients can be as high as 92.3% and 88.9%.\u003c/p\u003e \u003cp\u003eHFNC is a noninvasive oxygen therapy method that has been widely applied in short surgeries performed under general anesthesia.\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e It delivers oxygen through a dedicated nasal cannula at a flow rate exceeding the patient's minute ventilation, thereby creating positive pressure in the upper airway to maintain alveolar patency.\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e Studies revealed that HFNC oxygen therapy ensures an adequate positive end-expiratory pressure by delivering oxygen at a rate of 35 L/min, resulting in a nasopharyngeal airway pressure of 2.7 cmH\u003csub\u003e2\u003c/sub\u003eO and increased lung capacity in adult patients with closed mouths. Moreover, in premature infants, a high-flow rate of 2 L/kg/min can result in a nasopharyngeal pressure\u0026thinsp;\u0026gt;\u0026thinsp;2.62 cmH\u003csub\u003e2\u003c/sub\u003eO.\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e SHIH et al.\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e found that HFNC oxygen therapy can maintain PEEP in spontaneously breathing patients by providing continuous positive airway pressure, effectively avoiding postoperative atelectasis in adult patients. In addition, during HFNC oxygen therapy, the oxygen is maintained at a constant temperature and humidity, thus improving ciliary mucosal function, promoting secretion clearance, preventing airway obstruction, and preventing atelectasis.\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e This study revealed that HFNC oxygen therapy can significantly reduce the LUS at the end of surgery and discharge from the PACU as well as reduce the incidence of postoperative atelectasis to 63% in children undergoing interventional treatment for vascular malformations. The findings presented here are similar to those of previous research.\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e However, we found that HFNC oxygen therapy cannot completely prevent postoperative atelectasis in children, possibly because a HFNC delivers a high concentration of oxygen. Moreover, HFNC oxygen therapy may increase the absorption of residual gas in the alveoli, leading to alveolar collapse and therefore a reduced respiratory rate in children under anesthesia and possibly atelectasis.\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHFNC oxygen therapy can effectively improve oxygenation, extend the time of deoxygenation, and effectively prevent the occurrence of hypoxemia.\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e LIN et al.\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e conducted a large-scale randomized controlled trial and reported that in 1994 patients who underwent painless gastroscopy, HFNC oxygen therapy effectively prevented the occurrence of hypoxia during the procedure. Moreover, previous studies revealed that the use of a HFNC during sedation can reduce the need for tracheal intubation in patients undergoing endoscopic retrograde cholangiopancreatography and endoscopic ultrasound, thus reducing the risk associated with invasive airway procedures.\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e In this study, we observed that group H had a higher PaO\u003csub\u003e2\u003c/sub\u003e value at the end of surgery than group M did, however, there was no statistically significant difference in the incidence of hypoxemia (SpO2\u0026thinsp;\u0026lt;\u0026thinsp;92%) among the three groups of children. This may be because only children with healthy lungs before surgery were included in our study, thus potentially decreasing the benefit of HFNC oxygen therapy in this regard.\u003c/p\u003e \u003cp\u003eHERMEZ et al.\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e reported that, compared with conventional oxygen therapy, HFNC oxygen therapy can improve CO\u003csub\u003e2\u003c/sub\u003e clearance as a result of the combined effect of supraglottic gas vortices and strong turbulence generated by high-flow gas delivery and cardiogenic oscillations. Although we found that the PaCO\u003csub\u003e2\u003c/sub\u003e values of group M (48.69 mmHg) and group H (51.07 mmHg) were significantly greater than that of group T (40.93 mmHg) at the end of surgery, they were still within the safe range. This finding indicates that HFNC oxygen therapy can be safely administered to pediatric patients undergoing interventional treatment for vascular malformation, but it is still necessary to monitor the patient's PaCO\u003csub\u003e2\u003c/sub\u003e during the operation to avoid possible CO\u003csub\u003e2\u003c/sub\u003e accumulation and severe hypercapnia over time.\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e In addition, heated and humidified gas can be delivered via a HFNC, effectively improving the patient comfort during oxygen therapy\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Our study revealed that, compared with group T, group H had a shorter recovery time; a lower incidence of postoperative restlessness, nausea, and vomiting; and no increased risk of other adverse reactions.\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, this was a single-center, small-sample study, and patients known to have difficult airways and abnormal preoperative lung function were excluded. Multicenter, large-sample studies are urgently needed for further confirmation of the findings presented here. Second, HFNC oxygen therapy can increase airway pressure during closed-mouth breathing. Although each child underwent a comprehensive examination, some still breathed with their mouths open during the interventional procedure, which may have led to the inability to maintain the positive airway pressure promoted by HFNC oxygen therapy.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn summary, HFNC oxygen therapy during DSA-guided interventional treatment for vascular malformations can reduce the postoperative LUS and decrease the incidence of postoperative atelectasis in children, as it ensures adequate oxygenation during surgery under general anesthesia, and reduces the risks of emergence agitation and nausea and vomiting potentially caused by endotracheal intubation without promoting excessive CO\u003csub\u003e2\u003c/sub\u003e accumulation or increasing the risk of other adverse reactions. Whether intraoperative HFNC oxygen therapy reduces the risk of long-term postoperative pulmonary complications in children at high risk for postoperative pulmonary complications requires further investigation.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eVMs vascular malformations\u003c/p\u003e\n\u003cp\u003eHFNC\u0026nbsp;High - Flow Nasal Cannula\u003c/p\u003e\n\u003cp\u003ePPCs\u0026nbsp;Postoperative Pulmonary Complications\u003c/p\u003e\n\u003cp\u003ePEEP\u0026nbsp;Positive End - Expiratory Pressure\u003c/p\u003e\n\u003cp\u003eASA\u0026nbsp;American Society of Anesthesiologists\u003c/p\u003e\n\u003cp\u003eBMI\u0026nbsp;Body Mass Index\u003c/p\u003e\n\u003cp\u003ePAED Pediatric Anesthesia Emergence Delirium\u003c/p\u003e\n\u003cp\u003eLUS\u0026nbsp;Lung Ultrasound\u003c/p\u003e\n\u003cp\u003eABG Aarterial blood gas analysis\u003c/p\u003e\n\u003cp\u003eANOVA Analysis of variance\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Ethical approval was obtained from the Research Ethics Committee of the first affiliated of Gannan Medical University (reference number: LLSC-2023486) on November 28, 2023. The trial was registered online on December 14 2023 in the Chinese Clinical Trial Registry (ChiCTR2300078634, https://www.chictr.org.cn), and the first patient was enrolled on January 3, 2024. Written informed consent was obtained from all participants in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data cannot be fully disclosed due to privacy, ethical or other reasons. If necessary, one can apply to the Ethics Committee of the First Affiliated Hospital of Gannan Medical University, or contact the authors and meet certain cooperation conditions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting of interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo external funds were received to support this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMZF contributed to writing the original draft, reviewing and editing, conceptualization, visualization, methodology, project administration, formal analysis, and investigation. ZM and WLF participated in investigation, writing review and editing, data curation, and resources. HR ZLF and LH\u0026nbsp;was responsible for data curation, formal analysis, investigation, visualization, and software.\u0026nbsp;ZML\u0026nbsp;handled conceptualization, writing review and editing, visualization, methodology, supervision, validation, resources, project administration, and formal analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the subjects in this study for their indispensable assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNGUYEN HL, BONADURER G F, TOLLEFSON MM. Vascular Malformations and Health-Related Quality of Life[J]. JAMA Dermatol. 2018;154(6):661\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePARK HS, DO Y S, PARK K B, et al. Clinical Outcome and Predictors of Treatment Response in Foam Sodium Tetradecyl Sulfate Sclerotherapy of Venous Malformations[J]. Eur Radiol. 2016;26(5):1301\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSONG I-K, KIM E-H, LEE J-H, et al. Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery: A Randomized Controlled Trial[J]. Anesthesiology. 2018;128(4):718\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGAINSBURG DM. Anesthetic Concerns for Robotic-Assisted Laparoscopic Radical Prostatectomy[J]. Minerva Anestesiol. 2012;78(5):596\u0026ndash;604.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIU Z-H BOUHEMADB. Ultrasound Assessment of Antibiotic-Induced Pulmonary Reaeration in Ventilator-Associated Pneumonia[J]. Crit Care Med. 2010;38(1):84\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJIANG Z, LIU S, WANG L, et al. Effects of 30% vs. 60% Inspired Oxygen Fraction during Mechanical Ventilation on Postoperative Atelectasis: A Randomised Controlled Trial[J]. BMC Anesthesiol. 2023;23(1):265.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRESTREPO RD. Current Challenges in the Recognition, Prevention and Treatment of Perioperative Pulmonary Atelectasis[J]. Expert Rev Respir Med. 2015;9(1):97\u0026ndash;107.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDUGGAN M, KAVANAGH BP. Pulmonary Atelectasis: A Pathogenic Perioperative Entity[J]. Anesthesiology. 2005;102(4):838\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSREENAN C, LEMKE R P, HUDSON-MASON A, et al. High-Flow Nasal Cannulae in the Management of Apnea of Prematurity: A Comparison With Conventional Nasal Continuous Positive Airway Pressure[J]. Pediatrics. 2001;107(5):1081\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHELVIZ Y. A Systematic Review of the High-Flow Nasal Cannula for Adult Patients[J]. Crit Care. 2018;22(1):71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLEE, J-H, JI S-H, JANG Y-E, et al. Application of a High-Flow Nasal Cannula for Prevention of Postextubation Atelectasis in Children Undergoing Surgery: A Randomized Controlled Trial[J]. Anesth Analg. 2021;133(2):474\u0026ndash;82.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHIOJI N, IWASAKI T, KANAZAWA T, et al. Physiological Impact of High-Flow Nasal Cannula Therapy on Postextubation Acute Respiratory Failure after Pediatric Cardiac Surgery: A Prospective Observational Study[J]. J Intensive Care. 2017;5:35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRONCIN C, SCEMAMA U. Atelectasis Prevention during Anaesthesia Using High-Flow Nasal Cannula Therapy: A Paediatric Randomised Trial Using MRI Images[J]. Anaesth Crit Care Pain Med. 2020;39(6):819\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eX Y, Z Z. Y Z, Performance of Lung Ultrasound in Detecting Peri-Operative Atelectasis after General Anesthesia[J/OL]. Ultrasound Med Biol, 2016, 42(12)[2025-02-10]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/27639431/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/27639431/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eREN Y, LIU J, NIE X, et al. Association of Tidal Volume during Mechanical Ventilation with Postoperative Pulmonary Complications in Pediatric Patients Undergoing Major Scoliosis Surgery[J]. Paediatr Anaesth. 2020;30(7):806\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHUMPHREYS S, LEE-ARCHER P, REYNE G, et al. Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) in Children: A Randomized Controlled Trial[J]. Br J Anaesth. 2017;118(2):232\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eACOSTA C M, MAIDANA G A, JACOVITTI D, et al. Accuracy of Transthoracic Lung Ultrasound for Diagnosing Anesthesia-Induced Atelectasis in Children[J]. Anesthesiology. 2014;120(6):1370\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSONG I-K, KIM E-H, LEE J-H, et al. Effects of an Alveolar Recruitment Manoeuvre Guided by Lung Ultrasound on Anaesthesia-Induced Atelectasis in Infants: A Randomised, Controlled Trial[J]. Anaesthesia. 2017;72(2):214\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePARK S, LEE J H, KIM HJ, et al. Optimal Positive End-Expiratory Pressure to Prevent Anaesthesia-Induced Atelectasis in Infants: A Prospective, Randomised, Double-Blind Trial[J]. Eur J Anaesthesiol. 2021;38(10):1019\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWASSEF M, BLEI F. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies[J]. Pediatrics. 2015;136(1):e203\u0026ndash;214.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRANJITHA Y S ZADKARS, MISHRA P, et al. High-Flow Nasal Cannula (HFNC) Oxygenation for Sclerotherapy of Facial and Upper Airway Vascular Malformations in Pediatric Patients: Case Series[J]. J Anaesthesiol Clin Pharmacol. 2023;39(2):309\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePARKE R, MCGUINNESS S. Nasal High-Flow Therapy Delivers Low Level Positive Airway Pressure[J]. Br J Anaesth. 2009;103(6):886\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCORLEY A, CARUANA L R, BARNETT A G, et al. Oxygen Delivery through High-Flow Nasal Cannulae Increase End-Expiratory Lung Volume and Reduce Respiratory Rate in Post-Cardiac Surgical Patients[J]. Br J Anaesth. 2011;107(6):998\u0026ndash;1004.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSHIH C-C, LIANG P-C, CHUANG Y-H, et al. Effects of High-Flow Nasal Oxygen during Prolonged Deep Sedation on Postprocedural Atelectasis: A Randomised Controlled Trial[J]. Eur J Anaesthesiol. 2020;37(11):1025\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eM N. High-Flow Nasal Cannula Oxygen Therapy in Adults[J/OL]. J Intensive Care, 2015, 3(1)[2024-11-26]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://pubmed.ncbi.nlm.nih.gov/25866645/\u003c/span\u003e\u003cspan address=\"https://pubmed.ncbi.nlm.nih.gov/25866645/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMISHIMA G, SANUKI T, REVIE J, et al. Nasal High Flow Improves Ventilation during Propofol Sedation: A Randomized Cross-over Study in Healthy Volunteers[J]. Respir Physiol Neurobiol. 2020;277:103429.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLIN Y, ZHANG X, LI L, et al. High-Flow Nasal Cannula Oxygen Therapy and Hypoxia during Gastroscopy with Propofol Sedation: A Randomized Multicenter Clinical Trial[J]. Gastrointest Endosc. 2019;90(4):591\u0026ndash;601.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLA COMBE B, MESSIKA J. Increased Use of High-Flow Nasal Oxygen during Bronchoscopy[J]. Eur Respir J. 2016;48(2):590\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSCHUMANN R, NATOV N S, ROCUTS-MARTINEZ K A, et al. High-Flow Nasal Oxygen Availability for Sedation Decreases the Use of General Anesthesia during Endoscopic Retrograde Cholangiopancreatography and Endoscopic Ultrasound[J]. World J Gastroenterol. 2016;22(47):10398\u0026ndash;405.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHERMEZ L A, SPENCE C J, PAYTON M J, et al. A Physiological Study to Determine the Mechanism of Carbon Dioxide Clearance during Apnoea When Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)[J]. Anaesthesia. 2019;74(4):441\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGUSTAFSSON I-M, LODENIUS \u0026Aring;, TUNELLI J, et al. Apnoeic Oxygenation in Adults under General Anaesthesia Using Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) - a Physiological Study[J]. Br J Anaesth. 2017;118(4):610\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCUQUEMELLE E, PHAM T, PAPON J-F, et al. Heated and Humidified High-Flow Oxygen Therapy Reduces Discomfort during Hypoxemic Respiratory Failure[J]. Respir Care. 2012;57(10):1571\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Lung Ultrasonography, Atelectasis, Pediatric Anesthesia, HFNC","lastPublishedDoi":"10.21203/rs.3.rs-6452369/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6452369/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eChildren undergoing interventional treatment for vascular malformations (VMs) can easily develop perioperative atelectasis. High-flow nasal cannula (HFNC) oxygen therapy shows the potential to reduce perioperative atelectasis. The aim of our study was to explore the potential efficacy of HFNC oxygen therapy for reducing the incidence of perioperative atelectasis in Pediatric interventional treatment for vascular malformations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis study was a prospective randomized controlled trial with patientblind structure. A total of 81 pediatric patients scheduled for interventional sclerotherapy for VMs were randomly divided into three groups: the mask oxygenation group (Group M) (n\u0026thinsp;=\u0026thinsp;27), the endotracheal intubation group (Group T) (n\u0026thinsp;=\u0026thinsp;27), and the HFNC group (Group H) (n\u0026thinsp;=\u0026thinsp;27). The incidence of atelectasis was assessed at T\u003csub\u003e1\u003c/sub\u003e (at the end of surgery) and T\u003csub\u003e2\u003c/sub\u003e (upon discharge from the PACU).Other intraoperative and postoperative outcomes were also evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 80 pediatric surgical patients were included (26 patients in Group M, 27 patients in Group T, and 27 patients in Group H). At T\u003csub\u003e2\u003c/sub\u003e, significant atelectasis was observed in 17, 24, and 24 pediatric patients in Groups H, M, and T, respectively (63% \u003cem\u003evs.\u003c/em\u003e 88.9% \u003cem\u003evs.\u003c/em\u003e 92.3%; \u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011). The awakening time, PAED score, incidence of agitation during awakening, and incidence of postoperative nausea and vomiting in Group M and Group H were significantly lower than those in Group T (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHFNC oxygen therapy can reduce the incidence of atelectasis after pediatric interventional procedures for vascular malformations, prevent excessive CO\u003csub\u003e2\u003c/sub\u003e retention and other adverse reactions.\u003c/p\u003e\u003ch2\u003eTrial Registration:\u003c/h2\u003e \u003cp\u003eChinese Clinical Trial Registration number: ChiCTR2300078634\u003c/p\u003e","manuscriptTitle":"Effect of High-Flow Nasal Cannula Oxygen Therapy On The Postoperative Atelectasis in Interventional Sclerotherapy: A Randomized Controlled Trial","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-07 06:34:50","doi":"10.21203/rs.3.rs-6452369/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-19T08:59:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-15T13:08:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-14T01:48:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149437908664259980448762558841896783800","date":"2025-05-12T06:29:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"236900586080580453679137463665220698038","date":"2025-05-08T19:19:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"242474694487541211846414807260433460142","date":"2025-05-08T18:55:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2795545425777163552246941888482324297","date":"2025-05-08T10:10:20+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-08T07:51:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211068744111649959440941572425097140807","date":"2025-04-28T23:55:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-28T16:36:12+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-28T16:30:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-24T05:16:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-23T15:00:33+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Anesthesiology","date":"2025-04-23T14:59:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-anesthesiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bane","sideBox":"Learn more about [BMC Anesthesiology](http://bmcanesthesiol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bane","title":"BMC Anesthesiology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f76f7be4-99b5-4234-b881-b6343daf6a9e","owner":[],"postedDate":"May 7th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-07-07T16:00:56+00:00","versionOfRecord":{"articleIdentity":"rs-6452369","link":"https://doi.org/10.1186/s12871-025-03192-x","journal":{"identity":"bmc-anesthesiology","isVorOnly":false,"title":"BMC Anesthesiology"},"publishedOn":"2025-07-01 15:57:15","publishedOnDateReadable":"July 1st, 2025"},"versionCreatedAt":"2025-05-07 06:34:50","video":"","vorDoi":"10.1186/s12871-025-03192-x","vorDoiUrl":"https://doi.org/10.1186/s12871-025-03192-x","workflowStages":[]},"version":"v1","identity":"rs-6452369","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6452369","identity":"rs-6452369","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}