Use of high flow nasal cannula in critical burn patient during deep sedation in enzymatic bromelain debridement (nexobrid ® ): a single center brief report

The use of new oxygen supports associated to non-invasive respiratory strategies is well-established in clinical practice, especially after its extensive application in the management of Covid-19 respiratory failure. The use of high flow nasal cannula (HFNC) in patients undergoing procedural sedation and analgesia (PSA) is dramatically increasing. Enzymatic debridement in critical burn patients is a painful treatment that requires an optimal burn pain control protocol as well as a deep sedation for the entire duration of the procedure. Both hypnosis and opioid-analgesia may lead to significant respiratory depression. Fourteen patients undergoing enzymatic debridement under deep sedation have been included in this case study. All patients receiving oxygen through HFNC were evaluated. All patients underwent continuous monitoring of vital parameters, antithrombotic prophylaxis with low molecular weight heparins and fluid therapy calculated using the Parkland formula. Sedation was successful and well tolerated by all patients and physicians were able to carry out the enzymatic debridement procedure safely. No severe desaturation events were observed. Continuous monitoring of vital signs was carried out. Neither bradycardia events nor hypotensive or hypertensive events requiring treatment occurred. Enzymatic debridement procedures did not lead to any serious adverse events. Based on our experience, the administration of O2 by HFNC at an average concentration of 50% was proven safe and efficacious in the management of drug-induced respiratory depression.