Background

Oxygenation via a high-flow nasal cannula (HFNC) can be an alternative to tracheal intubation during short apnoeic procedures. This randomised, non-inferiority study assessed the efficacy of HFNC compared with tracheal intubation in laryngeal microsurgery.

Methods

Patients (≥20 yr old) undergoing laryngeal microsurgery under general anaesthesia and neuromuscular blockade were randomised to either the HFNC or tracheal intubation groups. The primary endpoint was lowest pulse oxygen saturation (SpO₂) during the first 30 min of surgery. Secondary endpoints included incidence of desaturation (SpO₂ <95%), hypercarbia (transcutaneous carbon dioxide [CO₂] ≥8.7 kPa), and rescue intervention.

Results

Amongst 130 patients randomised, 118 were included in the analysis. The lowest SpO₂ was 100 (98–100)% in the HFNC group (n=56) and 100 (100–100)% in the tracheal intubation group (n=62), with a mean difference of –1.4% (95% confidence interval: –2.4% and –0.3%), failing to confirm non-inferiority with a non-inferiority margin of 2%. The peak transcutaneous CO₂ and end-tidal CO₂ at the end of surgery were higher in the HFNC group compared with the tracheal intubation group. Incidences of desaturation, hypercarbia, and rescue intervention were more frequent in patients receiving HFNC compared with tracheal intubation.

Conclusions

HFNC oxygenation was not non-inferior to tracheal intubation for maintaining oxygen saturation during laryngeal microsurgery. Considering more frequent desaturation, hypercarbia, and requirement for rescue intervention compared with tracheal intubation, HFNC should be used with cautious monitoring even for short duration airway surgery.

Clinical trial registration

NCT03629353.

中文翻译：

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喉显微手术期间高流量鼻氧合与气管插管氧合的疗效比较：一项随机非劣效性研究

背景

在短暂的窒息手术中，通过高流量鼻导管 (HFNC) 给氧可以替代气管插管。这项随机、非劣效性研究评估了 HFNC 与气管插管在喉显微外科手术中的疗效。

方法

在全身麻醉和神经肌肉阻滞下接受喉显微手术的患者（≥20 岁）被随机分配到 HFNC 组或气管插管组。主要终点是手术前 30 分钟内的最低脉搏氧饱和度 (Sp O _{2 )。}次要终点包括去饱和（Sp O ₂ <95%）、高碳酸血症（经皮二氧化碳 [CO ₂ ] ≥8.7 kPa）和救援干预的发生率。

结果

在随机分组的 130 名患者中，118 名患者被纳入分析。HFNC 组 ( n =56)的最低 SpO ₂为 100 (98–100)% ，气管插管组 ( n =62) 为 100 (100–100)%，平均差异为 –1.4% (95 % 置信区间：–2.4% 和 –0.3%），未能以 2% 的非劣效性边际确认非劣效性。与气管插管组相比，HFNC组手术结束时的经皮CO ₂峰值和呼气末CO _{2峰值更高。}与气管插管相比，接受 HFNC 的患者发生去饱和、高碳酸血症和抢救干预的发生率更高。

结论

在喉显微手术期间，HFNC 氧合在维持氧饱和度方面并不逊于气管插管。与气管插管相比，考虑到更频繁的去饱和、高碳酸血症和抢救干预的需求，即使是短期气道手术，也应谨慎使用 HFNC。

临床试验注册

NCT03629353。