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Background <p>Patients undergoing non-elective surgery frequently require rapid sequence induction (RSI) because of concerns related to recent oral intake, impaired gastric emptying, or uncertain fasting status. Previous randomized controlled trials have reported mixed results regarding the effectiveness of high-flow nasal cannula (HFNC) in preventing oxygen desaturation during RSI. This study evaluated the effect of HFNC compared with facemask ventilation (FMV) during RSI in a non-elective surgical population.</p> Methods <p>In this randomized controlled study, adult ASA I–II patients undergoing non-elective surgery were allocated to HFNC (100% O₂, 60 L·min⁻<sup>1</sup>) or FMV (FiO₂ 1.0, 10 L·min⁻<sup>1</sup>) during RSI. A modified RSI protocol was applied, including predefined induction agents, cricoid pressure, gentle facemask ventilation as needed, and cuffed tracheal intubation. The primary outcome was peri-intubation oxygenation. Secondary outcomes included CO₂ accumulation, hemodynamic variables, gastric volume, patient comfort, and adverse events. Trial registration was performed retrospectively.</p> Results <p>Among 214 analyzed patients (107 per group), no desaturation events (SpO₂ &lt; 94%) occurred in the HFNC group versus 12.1% in FMV (<i>p</i> &lt; 0.001). HFNC yielded higher PaO₂ after preoxygenation (445.7 ± 16.8 vs. 314.2 ± 14.5&#xa0;mmHg) and after intubation (405.5 ± 17.7 vs. 236.5 ± 58.5&#xa0;mmHg; both p &lt; 0.001). End-tidal oxygen concentrations were also higher with HFNC (86.0 ± 11.4% vs. 75.7 ± 12.3%; <i>p</i> &lt; 0.001). CO₂ accumulation, hemodynamic variables, gastric volume, and aspiration incidence were similar between groups. Mild nasal dryness reduced comfort with HFNC, and one patient withdrew because of discomfort; overall tolerance remained acceptable.</p> Conclusion <p>HFNC appeared to improve oxygenation compared with FMV in this low-risk, non-elective surgical cohort. Within the limits of this physiologically stable population, HFNC was well tolerated and did not increase measured gastric or hemodynamic complications.</p> Trial registration <p>ClinicalTrials, NCT06879600. Retrospectively registered on 05 March 2025, <a href="https://clinicaltrials.gov/study/NCT06879600">https://clinicaltrials.gov/study/NCT06879600</a>.</p>

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High-flow nasal oxygen versus face-mask ventilation for rapid sequence induction in non-elective surgical patients: a randomized controlled trial

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月31日

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  • Nguyen Duc Lam,
  • Le Dinh Thanh Son,
  • Tran Minh Phat,
  • Nguyen Dang Thu,
  • Nguyen Thuy Nga,
  • Vuong Trung Son,
  • Bui Minh Hong

摘要

Background

Patients undergoing non-elective surgery frequently require rapid sequence induction (RSI) because of concerns related to recent oral intake, impaired gastric emptying, or uncertain fasting status. Previous randomized controlled trials have reported mixed results regarding the effectiveness of high-flow nasal cannula (HFNC) in preventing oxygen desaturation during RSI. This study evaluated the effect of HFNC compared with facemask ventilation (FMV) during RSI in a non-elective surgical population.

Methods

In this randomized controlled study, adult ASA I–II patients undergoing non-elective surgery were allocated to HFNC (100% O₂, 60 L·min⁻1) or FMV (FiO₂ 1.0, 10 L·min⁻1) during RSI. A modified RSI protocol was applied, including predefined induction agents, cricoid pressure, gentle facemask ventilation as needed, and cuffed tracheal intubation. The primary outcome was peri-intubation oxygenation. Secondary outcomes included CO₂ accumulation, hemodynamic variables, gastric volume, patient comfort, and adverse events. Trial registration was performed retrospectively.

Results

Among 214 analyzed patients (107 per group), no desaturation events (SpO₂ < 94%) occurred in the HFNC group versus 12.1% in FMV (p < 0.001). HFNC yielded higher PaO₂ after preoxygenation (445.7 ± 16.8 vs. 314.2 ± 14.5 mmHg) and after intubation (405.5 ± 17.7 vs. 236.5 ± 58.5 mmHg; both p < 0.001). End-tidal oxygen concentrations were also higher with HFNC (86.0 ± 11.4% vs. 75.7 ± 12.3%; p < 0.001). CO₂ accumulation, hemodynamic variables, gastric volume, and aspiration incidence were similar between groups. Mild nasal dryness reduced comfort with HFNC, and one patient withdrew because of discomfort; overall tolerance remained acceptable.

Conclusion

HFNC appeared to improve oxygenation compared with FMV in this low-risk, non-elective surgical cohort. Within the limits of this physiologically stable population, HFNC was well tolerated and did not increase measured gastric or hemodynamic complications.

Trial registration

ClinicalTrials, NCT06879600. Retrospectively registered on 05 March 2025, https://clinicaltrials.gov/study/NCT06879600.