Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery
Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen...
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| Veröffentlicht in: | British journal of anaesthesia : BJA 2023-01, Vol.130 (1), p.103-110 |
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| container_title | British journal of anaesthesia : BJA |
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| creator | Schutzer-Weissmann, John Wojcikiewicz, Thomas Karmali, Anil Lukosiute, Asta Sun, Ruoyi Kanji, Rafiq Ahmed, Ahmed R. Purkayastha, Sanjay Brett, Stephen J. Cousins, Jonathan |
| description | Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients.
Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min−1) or facemask (15 L min−1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%.
Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18–18 min) and the Facemask (inter-quartile range [IQR], 4.1–18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11–0.65; P=0.007).
In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery.
NCT03428256. |
| doi_str_mv | 10.1016/j.bja.2021.12.011 |
| format | Article |
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Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min−1) or facemask (15 L min−1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%.
Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18–18 min) and the Facemask (inter-quartile range [IQR], 4.1–18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11–0.65; P=0.007).
In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery.
NCT03428256.</description><identifier>ISSN: 0007-0912</identifier><identifier>EISSN: 1471-6771</identifier><identifier>DOI: 10.1016/j.bja.2021.12.011</identifier><identifier>PMID: 35027169</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Administration, Intranasal ; Apnea - therapy ; apnoeic oxygenation ; apnoeic ventilation ; bariatric anaesthesia ; desaturation risk ; high-flow nasal oxygen ; Humans ; Masks - adverse effects ; obesity ; Obesity, Morbid - complications ; Obesity, Morbid - therapy ; Oxygen ; Oxygen Inhalation Therapy - adverse effects ; Respiration and the Airway ; safe apnoea time ; THRIVE</subject><ispartof>British journal of anaesthesia : BJA, 2023-01, Vol.130 (1), p.103-110</ispartof><rights>2021 The Authors</rights><rights>Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.</rights><rights>2021 The Authors 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c451t-ca7f7f6e5d06c3cf95456f00618bd2331c4cc0dad8ba255a87b88da7198481ce3</citedby><cites>FETCH-LOGICAL-c451t-ca7f7f6e5d06c3cf95456f00618bd2331c4cc0dad8ba255a87b88da7198481ce3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35027169$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schutzer-Weissmann, John</creatorcontrib><creatorcontrib>Wojcikiewicz, Thomas</creatorcontrib><creatorcontrib>Karmali, Anil</creatorcontrib><creatorcontrib>Lukosiute, Asta</creatorcontrib><creatorcontrib>Sun, Ruoyi</creatorcontrib><creatorcontrib>Kanji, Rafiq</creatorcontrib><creatorcontrib>Ahmed, Ahmed R.</creatorcontrib><creatorcontrib>Purkayastha, Sanjay</creatorcontrib><creatorcontrib>Brett, Stephen J.</creatorcontrib><creatorcontrib>Cousins, Jonathan</creatorcontrib><title>Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery</title><title>British journal of anaesthesia : BJA</title><addtitle>Br J Anaesth</addtitle><description>Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients.
Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min−1) or facemask (15 L min−1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%.
Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18–18 min) and the Facemask (inter-quartile range [IQR], 4.1–18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11–0.65; P=0.007).
In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery.
NCT03428256.</description><subject>Administration, Intranasal</subject><subject>Apnea - therapy</subject><subject>apnoeic oxygenation</subject><subject>apnoeic ventilation</subject><subject>bariatric anaesthesia</subject><subject>desaturation risk</subject><subject>high-flow nasal oxygen</subject><subject>Humans</subject><subject>Masks - adverse effects</subject><subject>obesity</subject><subject>Obesity, Morbid - complications</subject><subject>Obesity, Morbid - therapy</subject><subject>Oxygen</subject><subject>Oxygen Inhalation Therapy - adverse effects</subject><subject>Respiration and the Airway</subject><subject>safe apnoea time</subject><subject>THRIVE</subject><issn>0007-0912</issn><issn>1471-6771</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU-P0zAQxS0EYsvCB-CCfOSS4HGa2AEJabXin7QSFzhbE3vSuiR2sdNCxZfHqy4ruHAaa_ybN6P3GHsOogYB3atdPeywlkJCDbIWAA_YCtYKqk4peMhWQghViR7kBXuS804IULJvH7OLphVSQdev2K-rfYjkLY8_TxsKuPgYuA98jmnwjseBsl9OrznyhMHF2Wdy3MawpDhN5bkkj1NpzHtMPmz4iJZmzN94ofnWb7bVOMUfPGAu2HkHdzT5I6XTU_ZoxCnTs7t6yb6-f_fl-mN18_nDp-urm8quW1gqi2pUY0etE51t7Ni367YbhehAD042Ddi1tcKh0wPKtkWtBq0dKuj1WoOl5pK9PevuD8NMzlK5HiezT37GdDIRvfn3J_it2cSj6bVqexBF4OWdQIrfD5QXU3ywNE0YKB6ykZ0sTiut-4LCGbUp5pxovF8DwtyGZnamhGZuQzMgTQmtzLz4-777iT8pFeDNGaDi0tFTMtl6CpacT2QX46L_j_xvzX2rfQ</recordid><startdate>20230101</startdate><enddate>20230101</enddate><creator>Schutzer-Weissmann, John</creator><creator>Wojcikiewicz, Thomas</creator><creator>Karmali, Anil</creator><creator>Lukosiute, Asta</creator><creator>Sun, Ruoyi</creator><creator>Kanji, Rafiq</creator><creator>Ahmed, Ahmed R.</creator><creator>Purkayastha, Sanjay</creator><creator>Brett, Stephen J.</creator><creator>Cousins, Jonathan</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20230101</creationdate><title>Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery</title><author>Schutzer-Weissmann, John ; Wojcikiewicz, Thomas ; Karmali, Anil ; Lukosiute, Asta ; Sun, Ruoyi ; Kanji, Rafiq ; Ahmed, Ahmed R. ; Purkayastha, Sanjay ; Brett, Stephen J. ; Cousins, Jonathan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c451t-ca7f7f6e5d06c3cf95456f00618bd2331c4cc0dad8ba255a87b88da7198481ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Administration, Intranasal</topic><topic>Apnea - therapy</topic><topic>apnoeic oxygenation</topic><topic>apnoeic ventilation</topic><topic>bariatric anaesthesia</topic><topic>desaturation risk</topic><topic>high-flow nasal oxygen</topic><topic>Humans</topic><topic>Masks - adverse effects</topic><topic>obesity</topic><topic>Obesity, Morbid - complications</topic><topic>Obesity, Morbid - therapy</topic><topic>Oxygen</topic><topic>Oxygen Inhalation Therapy - adverse effects</topic><topic>Respiration and the Airway</topic><topic>safe apnoea time</topic><topic>THRIVE</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schutzer-Weissmann, John</creatorcontrib><creatorcontrib>Wojcikiewicz, Thomas</creatorcontrib><creatorcontrib>Karmali, Anil</creatorcontrib><creatorcontrib>Lukosiute, Asta</creatorcontrib><creatorcontrib>Sun, Ruoyi</creatorcontrib><creatorcontrib>Kanji, Rafiq</creatorcontrib><creatorcontrib>Ahmed, Ahmed R.</creatorcontrib><creatorcontrib>Purkayastha, Sanjay</creatorcontrib><creatorcontrib>Brett, Stephen J.</creatorcontrib><creatorcontrib>Cousins, Jonathan</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>British journal of anaesthesia : BJA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schutzer-Weissmann, John</au><au>Wojcikiewicz, Thomas</au><au>Karmali, Anil</au><au>Lukosiute, Asta</au><au>Sun, Ruoyi</au><au>Kanji, Rafiq</au><au>Ahmed, Ahmed R.</au><au>Purkayastha, Sanjay</au><au>Brett, Stephen J.</au><au>Cousins, Jonathan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery</atitle><jtitle>British journal of anaesthesia : BJA</jtitle><addtitle>Br J Anaesth</addtitle><date>2023-01-01</date><risdate>2023</risdate><volume>130</volume><issue>1</issue><spage>103</spage><epage>110</epage><pages>103-110</pages><issn>0007-0912</issn><eissn>1471-6771</eissn><abstract>Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients.
Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min−1) or facemask (15 L min−1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%.
Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18–18 min) and the Facemask (inter-quartile range [IQR], 4.1–18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11–0.65; P=0.007).
In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery.
NCT03428256.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>35027169</pmid><doi>10.1016/j.bja.2021.12.011</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0007-0912 |
| ispartof | British journal of anaesthesia : BJA, 2023-01, Vol.130 (1), p.103-110 |
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| language | eng |
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| source | MEDLINE; Free E-Journal (出版社公開部分のみ）; Alma/SFX Local Collection |
| subjects | Administration, Intranasal Apnea - therapy apnoeic oxygenation apnoeic ventilation bariatric anaesthesia desaturation risk high-flow nasal oxygen Humans Masks - adverse effects obesity Obesity, Morbid - complications Obesity, Morbid - therapy Oxygen Oxygen Inhalation Therapy - adverse effects Respiration and the Airway safe apnoea time THRIVE |
| title | Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing facemask and high-flow nasal oxygen delivery |
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