High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: a systematic review and meta-analysis

Michael Doulberis; Fotios Sampsonas; Apostolis Papaefthymiou; Vasileios Karamouzos; Maria Lagadinou; Theodoros Karampitsakos; Grigorios Stratakos; Thomas Kuntzen; Argyrios Tzouvelekis

doi:10.1080/17476348.2022.2042256

High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: a systematic review and meta-analysis

Expert Rev Respir Med. 2022 Mar;16(3):323-332. doi: 10.1080/17476348.2022.2042256. Epub 2022 Feb 22.

Authors

Affiliations

¹ Division of Gastroenterology and Hepatology, Medical University Department, Kantonsspital Aarau, Aarau, Switzerland.
² First Laboratory of Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ Emergency Department, University Hospital Inselspital, Bern, Switzerland.
⁴ Respiratory Medicine Department, University Hospital of Patras, Rio, Greece.
⁵ Department of Gastroenterology, University Hospital of Larissa, Larissa, Greece.
⁶ Intensive Care Unit, University Hospital of Patras, Rio, Greece.
⁷ Department of Internal Medicine, University Hospital of Patras, Rio, Greece.
⁸ Interventional Pulmonology Unit, 1st Respiratory Medicine Department of the National, Kapodistrian University of Athens, Athens, Greece.

PMID: 35157538
DOI: 10.1080/17476348.2022.2042256

Abstract

Background: Gastrointestinal endoscopy (GIE) represents a mainstay diagnostic and therapeutic procedure in clinical practice. Hypoxemia constitutes a major complication for endoscopists. Emerging evidence supports the utilization of high-flow nasal cannula (HFNC) over conventional nasal cannula (CNC) for avoidance of hypoxemia. Our aim was to compare the hypoxemia risk in patients undergoing GIE with HFNC versus CNC oxygen supplementation recruited by randomized controlled trials (RCTs).

Methods: We searched in medical databases PubMed, EMBASE and Cochrane to identify RCTs investigating the abovementioned association. Enrolled studies were evaluated for risk of bias and inserted into a random effects model for meta-analysis; subgroup analyses and publication bias were also assessed.

Results: Out of 271 articles, five RCTs were eligible (patients n=2656, HFNC 1299 and CNC 1357). A statistically significant reduced relative risk (RR) of hypoxemia among HFNC patients was revealed (RR=0.18, CI95%: 0.05-0.61), whilst with high heterogeneity (I2:79.94%, p<0.01). Patients undergoing upper GIE with HFNC displayed a significantly lower hypoxemia risk (96%, p<0.001, I2:15.59%), even after exclusion of endoscopic retrograde cholangiopancreatography cases (RR:0.03, CI95%:0.01-0.21), albeit with higher heterogeneity (I2:41.82%). .

Conclusion: Patients undergoing upper GIE with HFNC experience significantly less hypoxemia burden than CNC counterparts. Further research is warranted to target optimal safety during endoscopy.Abbreviations: ASA, American Society of Anesthesiologists; ASGE, American Society for Gastrointestinal Endoscopy; BMI, Body Mass Index; CI, confidence interval; CNC, conventional nasal cannula; ERCP, endoscopic retrograde cholangiopancreatography; FiO_2, fraction of inspired O₂; GI, gastrointestinal; GIE, gastrointestinal endoscopies; HFNC, High-Flow nasal cannula; ICU, intensive care unit; PEEP, positive end-expiratory pressure; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RCTs, randomized control trials; RR, relative risk (or risk ratio).

Keywords: EGD; ERCP; Gastrointestinal endoscopies; HFNC; colonoscopy; digestive endoscopies; high-flow; high-flow nasal cannula; hypercapnia; hypoxemia.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Cannula* / adverse effects
Endoscopy, Gastrointestinal / adverse effects
Humans
Hypoxia / etiology
Hypoxia / therapy
Oxygen Inhalation Therapy / adverse effects
Oxygen Inhalation Therapy / methods
Oxygen*

Substances

Oxygen