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Objective <p>Although apnoeic oxygenation has demonstrated efficacy in extending safe apnea time during intubation, a superiority comparison between high-flow nasal cannula (HFNC) and low-flow nasal cannula (LFNC) in emergency settings remains unexplored. This randomized controlled trial evaluated whether apnoeic oxygenation using HFNC or LFNC with head elevation improves oxygenation and intubation outcomes compared to standard care without oxygen delivery.</p> Methods <p>We conducted a three-arm randomized trial using block randomization (1:1:1) at a tertiary care emergency department. Adult patients requiring intubation were randomized to receive apnoeic oxygenation via HFNC (20&#xa0;L/min), LFNC (10&#xa0;L/min), or standard care. The primary outcome was the lowest oxygen saturation 3&#xa0;min post-intubation, and co-primary outcome was first-pass success rate. Secondary outcomes were safe apnea time, post-intubation complications (hypotension, desaturation, arrhythmia), laryngoscopic view, and the need for adjuncts. Intention-to-treat analysis was applied.</p> Results <p>Our study investigated endotracheal intubation in 88 patients, divided into high flow, low flow, and standard care groups. The high flow group had the highest median SpO2 and less variability than other groups. The standard group had the highest first attempt success rate (93%). The high flow group had a statistically significant shorter Apnea duration than the low flow group. The low flow group had a higher prevalence of hypotension (46%) and oxygen desaturation (57%) post-intubation.</p> Conclusion <p>HFNC with head-elevated positioning reduces post-intubation desaturation and hypotension compared to LFNC and standard care. HFNC may be a beneficial adjunct during emergency intubation, particularly in patients at risk of hypoxia or hemodynamic instability.</p> Trial registration number <p>ClinicalTrials.gov Registry: <b>NCT04242537</b> on 2020-01-27.</p>

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Randomized controlled trial to assess the effectiveness of apnoeic oxygenation in adults using a low-flow or high-flow nasal cannula with head side elevation during endotracheal intubation in the emergency department

  • 期刊论文

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  • 发表日期：

    2025年7月1日

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  • Shahan Waheed,
  • Nazir Najeeb Kapadia,
  • Dr. Rida Jawed,
  • Ahmed Raheem,
  • Muhammad Faisal Khan

摘要

Objective

Although apnoeic oxygenation has demonstrated efficacy in extending safe apnea time during intubation, a superiority comparison between high-flow nasal cannula (HFNC) and low-flow nasal cannula (LFNC) in emergency settings remains unexplored. This randomized controlled trial evaluated whether apnoeic oxygenation using HFNC or LFNC with head elevation improves oxygenation and intubation outcomes compared to standard care without oxygen delivery.

Methods

We conducted a three-arm randomized trial using block randomization (1:1:1) at a tertiary care emergency department. Adult patients requiring intubation were randomized to receive apnoeic oxygenation via HFNC (20 L/min), LFNC (10 L/min), or standard care. The primary outcome was the lowest oxygen saturation 3 min post-intubation, and co-primary outcome was first-pass success rate. Secondary outcomes were safe apnea time, post-intubation complications (hypotension, desaturation, arrhythmia), laryngoscopic view, and the need for adjuncts. Intention-to-treat analysis was applied.

Results

Our study investigated endotracheal intubation in 88 patients, divided into high flow, low flow, and standard care groups. The high flow group had the highest median SpO2 and less variability than other groups. The standard group had the highest first attempt success rate (93%). The high flow group had a statistically significant shorter Apnea duration than the low flow group. The low flow group had a higher prevalence of hypotension (46%) and oxygen desaturation (57%) post-intubation.

Conclusion

HFNC with head-elevated positioning reduces post-intubation desaturation and hypotension compared to LFNC and standard care. HFNC may be a beneficial adjunct during emergency intubation, particularly in patients at risk of hypoxia or hemodynamic instability.

Trial registration number

ClinicalTrials.gov Registry: NCT04242537 on 2020-01-27.