High-flow nasal oxygenation versus face mask oxygenation for preoxygenation in patients undergoing double-lumen endobronchial intubation: protocol of a randomised controlled trial

Abstract

Introduction: With the growing emphasis on swift recovery, minimally invasive thoracic surgery has advanced significantly. Video-assisted thoracoscopic surgery (VATS) has seen rapid development, and the double-lumen tube (DLT) remains the most dependable method for tracheal intubation in VATS. However, hypoxaemia during DLT intubation poses a threat to the perioperative safety of thoracic surgery patients. Recently, transnasal high-flow nasal oxygen (HFNO) has shown promise in anaesthesia, particularly in handling short-duration hypoxic airway emergencies. Yet, its application in the perioperative period for patients undergoing pulmonary surgery with compromised cardiopulmonary function lacks evidence, and there are limited reliable clinical data.

Methods and analysis: A prospective, randomised, controlled, single-blind design will be employed in this study. 112 patients aged 18-60 years undergoing elective VATS-assisted pulmonary surgery will be enrolled and randomly divided into two groups: the nasal high-flow oxygen group (H group) and the traditional mask transnasal oxygen group (M group) in a 1:1 ratio. HFNO will be used during DLT intubation for the prevention of asphyxia in group H, while conventional intubation procedures will be followed by group M. Comparison will be made between the two groups in terms of minimum oxygen saturation during intubation, hypoxaemia incidence during intubation, perioperative complications and postoperative hospital days.

Ethics and dissemination: Approval for this study has been granted by the local ethics committee at Shenzhen Second People's Hospital. The trial results will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number: NCT05666908.

Keywords: double-lumen tube; high-flow nasal oxygenation; hypoxemia; thoracoscopic surgery; thoracoscopy pulmonary surgery; transnasal humidified rapid insufflation ventilatory exchange (THRIVE).