Klinik für HNO-Heilkunde, Kopf-/Halschirurgie, Plastische Operationen, Universitätsklinikum Gießen und Marburg, Justus-Liebig-Universität Gießen, Standort GießenKlinikstraße 33, D- 35392, Giessen, Germany.
Klinikum Dortmund, Klinik für HNO-Heilkunde, Dortmund, Germany.
Eur Arch Otorhinolaryngol. 2024 Sep;281(9):4889-4895. doi: 10.1007/s00405-024-08726-6. Epub 2024 May 16.
Highflow nasal cannula oxygen (HFNO) is known to be used for noninvasive oxygenation in intensive care patients but it has rarely been used in airway management for elective surgery of the upper aerodigestive tract.
HFNO offers opportunities of a tubeless oxygenation system which is easy to handle and not limited only on surgery of the endolarynx.
We evaluated this method for oxygenation during brief interventional procedures of the larynx and pharynx in 92 adult patients for safety and intraoperative complications. The need of secondary endotracheal intubation and limiting comorbidities as pulmonal and cardiac diseases were documented.
HFNO showed a good safety profile concerning saturation and hypercapnia. Oxygen desaturation below 90% occurred only in 5 patients, mask ventilation led to quick recovery except in one patient who was secondary intubated. A significant influence of the body mass index on the minimal O2 saturation was shown (p < 0,001) so that a possible limitation of the method exists here. Comorbidities were grouped into the ASA classification. There was a significant difference between ASA I/II and ASA III patients in terms of minimum O2saturation.
We conclude that HFNO may hold great promise for changing ventilator technique in general anesthesia, particularly in short elective laryngeal and pharyngeal surgery. Safety and feasibility were proven in this study.
高流量鼻导管吸氧（HFNO）已知可用于重症监护患者的无创氧合，但在耳鼻喉上气道择期手术的气道管理中很少使用。
HFNO 提供了无管氧合系统的机会，该系统易于操作，不仅限于喉内手术。
我们评估了 92 例成人患者在喉镜和咽部短程介入手术期间的氧合安全性和术中并发症。记录了需要二次气管插管和限制肺部和心脏疾病等合并症的情况。
HFNO 在饱和度和高碳酸血症方面显示出良好的安全性。只有 5 名患者出现氧饱和度低于 90%的情况，面罩通气迅速恢复，只有 1 名患者需要二次插管。体重指数对最低 O2 饱和度有显著影响（p<0.001），因此该方法可能存在局限性。合并症按 ASA 分类分组。ASA I/II 级和 ASA III 级患者的最低 O2 饱和度有显著差异。
我们得出结论，HFNO 可能为全麻中呼吸机技术的改变带来巨大希望，特别是在短时间的耳鼻喉择期手术中。本研究证明了其安全性和可行性。
