Gastroenterology · 3 h ago
High-flow oxygen reduced hypoxemia during sedated ERCP in randomized trial
In a two-center randomized trial of 300 adults undergoing prone-position ERCP with nurse-administered propofol sedation, high-flow nasal cannula oxygen was compared with standard nasal cannula oxygen. Hypoxemia and rescue airway interventions were less frequent with high-flow oxygen, while transient hypotension was more frequent.
- Randomized two-center trial enrolled 300 adults undergoing ERCP.
- Hypoxemia: 1.3% with high-flow versus 14.0% with standard oxygen.
- Airway rescue interventions were less frequent with high-flow oxygen.
- Hypotension was more frequent, without vasopressor use or procedure termination.
This prospective, two-center randomized trial enrolled 300 adults undergoing prone-position endoscopic retrograde cholangiopancreatography (ERCP) with nurse-administered propofol sedation. Participants were assigned to high-flow nasal cannula oxygen (50 L/min; FiO₂ 0.50) or standard nasal cannula oxygen (5 L/min). The primary outcome was oxygen saturation below 92% for more than 10 seconds; secondary outcomes included airway interventions and cardiovascular events.
Hypoxemia occurred in 2 of 150 patients (1.3%) receiving high-flow oxygen and 21 of 150 (14.0%) receiving standard oxygen (RR 0.10, 95% CI 0.02–0.36; P<0.001). Jaw thrust was used in 1.3% versus 12.0%, and nasopharyngeal airways were inserted in 0% versus 9.3%, respectively. No patient required emergency intubation. Hypotension was more frequent with high-flow oxygen (16.7% vs 8.0%; P=0.02), but no episode required vasopressors or procedure termination.
The findings suggest fewer hypoxemic events and airway interventions in this setting, alongside more frequent transient hypotension. The trial was conducted at two centers; the reported BMI subgroup analysis was post hoc and found no significant treatment-by-BMI interaction. The results apply to the studied ERCP and sedation context.
In practice
For adults undergoing prone-position ERCP with nurse-administered propofol sedation, this two-center randomized trial found substantially fewer episodes of hypoxemia and fewer rescue airway interventions with high-flow nasal cannula than with standard nasal cannula oxygen. Hypotension was more frequent with high-flow oxygen, although no episode required vasopressors or procedure termination. These findings support a potential benefit in the studied procedural setting, but evidence comes from 300 patients at two centers and does not establish effects in other procedures, sedation approaches, or practice settings.
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Surgical Endoscopy: High-flow versus standard nasal cannula oxygenation during prone-position ERCP under nurse-administered propofol sedation: a randomized controlled trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.