Work

Preoxygenation with high-flow nasal oxygen at various flow rates in elective surgical patients: a prospective, randomised, single-blind clinical trial

Year: 2025

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Background: High-flow nasal oxygen (HFNO) is increasingly used for preoxygenation.Previous studies of preoxygenation have explored flow rates below 60 L min -1 .This study aimed to compare different HFNO flow rates during preoxygenation to identify the most effective flow rate for clinical use.Methods: This randomised trial included patients aged 18-84 yr of ASA physical status 1-3 scheduled for elective surgery.Preoxygenation was conducted using HFNO at randomised flow rates of 45, 70, or 95 L min -1 .After preoxygenation, patients rated their level of preoxygenation-related discomfort.HFNO was discontinued at apnoea start.After intubation, apnoea was maintained until SpO 2 reached 93%.Primary outcome was apnoea time until SpO 2 =93%.Secondary outcomes were PaO 2 levels during preoxygenation and preoxygenation-related discomfort.Results: Of 72 participants included in the final analysis, baseline characteristics were similar and the mean duration of preoxygenation was 250 s in all three groups.Apnoea times did not differ, with median durations of 472, 523, and 483 s for 45, 70, and 95 L min -1 , respectively (P=0.59).At apnoea onset, 95 L min -1 produced higher PaO 2 than 45 L min -1 .No other differences in PaO 2 were observed during preoxygenation.The level of discomfort was lower for 45 L min -1 compared with 70 and 95 L min -1 .Conclusions: There was no difference in the safe apnoea time between preoxygenation with the three flow rates.As 45 L min -1 generated the least discomfort while providing preoxygenation effectiveness comparable with higher flow rates, increasing preoxygenation flow rate from 45 to 70 L min -1 will likely not prolong safe apnoea time.Clinical trial registration: NCT 06736132.

Source: British Journal of Anaesthesia

DOI: 10.1016/j.bja.2025.11.017

Authors: Albin Sjöblom, Frida Hoffman, Magnus Hedberg, Ida-Maria Forsberg, Malin Jonsson Fagerlund

Institutions: Karolinska University Hospital, Karolinska Institutet

Language: English

Topic: Airway Management and Intubation Techniques

Subfield: Anesthesiology and Pain Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,450