Formal Project Prize Session
Beneficial Effects of High Flow Nasal Cannula (HFNC) Versus Standard Low Flow Nasal Cannula in Patients Undergoing Left Atrial Appendage Occlusion (LAAO) under Deep Sedation: A Randomized Pilot Crossover Trial
Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Hong Kong
We conducted a pilot study to assess the feasibility of conducting a large scale randomized controlled trial to compare the rate of desaturation and safety in HFNC with that found with standard low flow nasal cannula (LFNC) in patients undergoing left atrial appendage occlusion (LAAO) under deep sedation.
In this prospective, randomised crossover pilot trial, patients undergoing LAAO with deep sedation were randomly assigned to the 2 sequence groups either LFNC followed by HFNC or vice versa with comparable FiO2. The primary outcomes were frequency of desaturation, rate of change of arterial blood gases parameters over time and need for airway manipulation by the anaesthesiologist in the event of upper airway obstruction.
We enrolled 30 patients and 15 were allocated to each group. The frequency of desaturation was significantly higher in the LFNC group compared with the HFNC group (p = 0.002). The mean episodes of jaw thrust by the anaesthesiologist in LFNC group was 1.59 compared with HFNC group of 0.74 (p = 0.013). No significant differences were found in arterial blood gas parameters. The study recruitment rate was 0.58 subjects per week over 52-week period. All enrolled patients had valid and complete primary outcome measure data. No adverse events were reported.
HFNC reduced the proportion of patients experiencing desaturation with less airway manipulation required during LAAO with deep sedation compared with standard low-flow oxygen therapy. It is feasible to carry on with a large scale randomised controlled trial for further evaluation of the beneficial effects of HFNC.