Oxygen concentration titration guided by oxygen reserve index during pediatric laryngeal surgery with high-flow nasal cannula oxygen: a randomized controlled trial

The objective of this study was to evaluate whether adjusting the oxygen concentration guided by the Oxygen Reserve Index (ORI) during pediatric laryngeal surgery with High Flow Nasal Cannula Oxygen (HFNO) could achieve postoperative PaO₂ close to physiological levels while ensuring adequate oxygenation in surgery.

Sixty pediatric patients undergoing laryngeal surgery or examination were randomly assigned to two groups. The ORI group received oxygen concentration adjustments every 5 min to maintain a target ORI value of 0.21, whereas the control group did not undergo any adjustments. Postoperative PaO₂, time weighted average fraction of inspired oxygen (FiO₂), and mean Peripheral Oxygen Saturation (SpO₂) were compared between groups. Finally, some analyses were conducted to examine the relationship of ORI with PaO₂.

In general, the postoperative PaO₂ was 164.9 ± 48.8 mmHg in ORI group and 323.0 ± 87.7 mmHg in control group (P < 0.01). The time weighted average FiO₂ in the ORI group was 85.9 [81.8–92.7] %. There was no significant difference in mean SpO₂ between the two groups (ORI vs. control: 98.4 [97.7–99.2] vs. 98.8 [97.7–99.5]; P = 0.36). According to the analyses, the optimal cut value for ORI was determined to be 0.195 when PaO₂ was 150 mmHg.

In pediatric laryngeal surgery with HFNO, reducing oxygen concentration guided by ORI helped achieve postoperative PaO₂ levels closer to physiological norms without compromising intra-operative oxygenation.