Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Aug 15:9:949614.
doi: 10.3389/fsurg.2022.949614. eCollection 2022.

High flow nasal cannula for patients undergoing bronchoscopy and gastrointestinal endoscopy: A systematic review and meta-analysis

Yuan Tao  1 , Mingyang Sun  1 , Mengrong Miao  1 , Yaqian Han  1 , Yitian Yang  1 , Xuhui Cong  1 , Jiaqiang Zhang  1
Affiliations
Review

High flow nasal cannula for patients undergoing bronchoscopy and gastrointestinal endoscopy: A systematic review and meta-analysis

Yuan Tao et al. Front Surg. .

Abstract

Background: High flow nasal cannula is gaining increasingly used in patients undergoing endoscopic procedures. We undertook this systematic review and meta-analysis to determine whether high flow nasal cannula (HFNC) could effectively minimize the risk of hypoxemia as compared with conventional oxygen therapy (COT).

Methods: We performed a comprehensive search of Pubmed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, and Web of Science. Studies involving the application of HFNC during endoscopic procedures were identified.

Results: We included 15 randomized controlled trials (7 bronchoscopy, 8 gastrointestinal endoscopy). Patients receiving HFNC during endoscopic procedures had a significantly lower risk of hypoxemia (defined as SpO2 < 90%) versus COT group (risk ratio = 0.32; 95%CI (0.22-0.47), 13 studies, 4,093 patients, moderate-quality evidence, I 2 = 48.82%, P < 0.001). The lowest SpO2 was significantly higher in HFNC group (mean difference = 4.41; 95%CI (2.95-5.86), 9 studies, 1,449 patients, moderate-quality evidence, I 2 = 81.17%, P < 0.001) than those receiving COT. No significant difference was detected between groups in end-procedure partial pressure of CO2 (standard mean difference = -0.18; 95%CI (-0.52-0.15), 5 studies, 238 patients, moderate-quality evidence, I 2 = 42.25%, P = 0.29). Patients receiving HFNC were associated a lower need for airway intervention (risk ratio = 0.45; 95%CI (0.24-0.84), 8 studies, 2,872 patients, moderate-quality evidence, I 2 = 85.97%, P = 0.01) and less procedure interruption (risk ratio = 0.36; 95%CI (0.26-0.51), 6 studies, 1,562 patients, moderate-quality evidence, I 2 = 0.00%, P < 0.001). The overall intubation rate after endoscopy was 0.20% in both group, with no difference detected (risk ratio = 1.00; 95%CI (0.30-3.35), 7 studies, 2,943 patients, low-quality evidence, I 2 = 0.00%, P = 1.00).

Conclusion: This systematic review and meta-analysis found moderate to low evidence that the application of HFNC was associated with improved oxygenation, decreased need for airway intervention, and reduced procedure interruption in patients undergoing endoscopic procedures. Future larger sample and high-quality studies are warranted to confirm our result and further investigate the effectiveness of HFNC in patients at risk. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42022298032.

Keywords: airway intervention; endoscopy; high flow nasal cannula; hypoxemia; meta-analysis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow diagram.
Figure 2
Figure 2
Forest plot comparing hypoxemia during the procedure in HFNC versus COT. HFNC, high flow nasal cannula; COT, conventional oxygen therapy; RR, risk ratio.
Figure 3
Figure 3
Forest plot comparing lowest SpO2 during the procedure in HFNC versus COT. HFNC, high flow nasal cannula; COT, conventional oxygen therapy; MD, mean difference.
Figure 4
Figure 4
Forest plot comparing end-procedure partial pressure of CO2 during the procedure in HFNC versus COT. HFNC, high flow nasal cannula; COT, conventional oxygen therapy; SMD, standard mean difference.
Figure 5
Figure 5
Forest plot comparing airway intervention during the procedure in HFNC versus COT. HFNC, high flow nasal cannula; COT, conventional oxygen therapy; RR, risk ratio.
Figure 6
Figure 6
Forest plot comparing procedure interruption during the procedure in HFNC versus COT. HFNC, high flow nasal cannula; COT, conventional oxygen therapy; RR, risk ratio.
Figure 7
Figure 7
Forest plot comparing incidence of intubation after the procedure in HFNC versus COT. HFNC, high flow nasal cannula; COT, conventional oxygen therapy; RR, risk ratio.
Figure 8
Figure 8
Funnel plot for publication bias.
Figure 9
Figure 9
Revised risk of bias of randomised controlled trials. Green circle, low risk; yellow circle, some concerns; red circle, high risk.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Behrens A, Kreuzmayr A, Manner H, Koop H, Lorenz A, Schaefer C, et al. Acute sedation-associated complications in Gi endoscopy (prosed 2 study): results from the prospective multicentre electronic registry of sedation-associated complications. Gut. (2019) 68(3):445–52. 10.1136/gutjnl-2015-311037 - DOI - PubMed
    1. McQuaid KR, Laine L. A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures. Gastrointest Endosc. (2008) 67(6):910–23. 10.1016/j.gie.2007.12.046 - DOI - PubMed
    1. Vargo JJ, Niklewski PJ, Williams JL, Martin JF, Faigel DO. Patient safety during sedation by anesthesia professionals during routine upper endoscopy and colonoscopy: an analysis of 1.38 million procedures. Gastrointest Endosc. (2017) 85(1):101–8. 10.1016/j.gie.2016.02.007 - DOI - PubMed
    1. Cohen LB, Wecsler JS, Gaetano JN, Benson AA, Miller KM, Durkalski V, et al. Endoscopic sedation in the United States: results from a nationwide survey. Am J Gastroenterol. (2006) 101(5):967–74. 10.1111/j.1572-0241.2006.00500.x - DOI - PubMed
    1. Bhananker SM, Posner KL, Cheney FW, Caplan RA, Lee LA, Domino KB. Injury and liability associated with monitored anesthesia care: a closed claims analysis. Anesthesiology. (2006) 104(2):228–34. 10.1097/00000542-200602000-00005 - DOI - PubMed