Tavşanoğlu Zeynep Yasemin, Yüksek Ahmet, Kavaklı Ali Sait, Arslan Ülkü, Yılmaz Mehmet
Department of Anesthesiology and Reanimation, Kocaeli City Hospital, Kocaeli, Türkiye, Turkey.
Department of Anesthesiology and Reanimation, Faculty of Medicine, Istinye University, Istanbul, Türkiye, Turkey.
BMC Anesthesiol. 2025 Jun 3;25(1):286. doi: 10.1186/s12871-025-03166-z.
High-flow nasal cannula (HFNC) oxygen therapy is a commonly used respiratory support method delivering heated, humidified air at high flow rates with a positive end-expiratory pressure (PEEP) effect. HFNC improves oxygenation and facilitates awake fiberoptic intubation in the management of difficult airways. However, concerns about HFNC-induced gastric insufflation and intestinal distension have emerged, particularly in patients with lower esophageal sphincter dysfunction or hiatal hernia. We report a case of severe intestinal distension following HFNC-assisted awake fiberoptic intubation in a patient with a hiatal hernia scheduled for laparoscopic Nissen fundoplication.
A 50-year-old male patient was scheduled for a Nissen fundoplication procedure. Following preoperative airway examination, it was decided to proceed with awake intubation. HFNC was used as recommended in the guidelines to improve oxygenation. The patient was intubated with minimal sedation and airway topicalization under 40 L/min flow using a fiberoptic bronchoscope. The procedure was uneventful and the patient was handed over to the surgical team. Surgery began laparoscopically. However, excessive intestinal distension did not allow the surgery to continue with an optimum image. Aspirations with an orogastric tube and rectal tube could not improve the image and the patient had to undergo open surgery. The 5-hour open surgical procedure was completed without complications. Postoperative direct abdominal radiography showed dense intestinal air compared to the preoperative radiography.
This case underscores the potential risk of HFNC-induced intestinal distension, particularly in patients with predisposing factors such as hiatal hernia. Although HFNC is effective for airway management, careful patient selection and technique optimization are crucial. Further research is needed to clarify the impact of HFNC on gastrointestinal dynamics and to guide its safe application in at-risk populations.
高流量鼻导管（HFNC）氧疗是一种常用的呼吸支持方法，可输送加热、加湿的高流量空气，并具有呼气末正压（PEEP）效应。HFNC在困难气道管理中可改善氧合并有助于清醒纤维支气管镜插管。然而，人们开始关注HFNC引起的胃充气和肠扩张，特别是在食管下括约肌功能障碍或食管裂孔疝患者中。我们报告一例计划行腹腔镜nissen胃底折叠术的食管裂孔疝患者，在HFNC辅助清醒纤维支气管镜插管后发生严重肠扩张的病例。
一名50岁男性患者计划行nissen胃底折叠术。术前气道检查后，决定进行清醒插管。按照指南建议使用HFNC改善氧合。患者在最小镇静和气道表面麻醉下，使用纤维支气管镜在40L/min流量下插管。手术过程顺利，患者被交给手术团队。腹腔镜手术开始。然而，过度的肠扩张导致无法获得最佳手术视野，手术无法继续进行。经口胃管和直肠管抽吸不能改善视野，患者不得不接受开放手术。5小时的开放手术顺利完成，无并发症。术后腹部直接X线摄影显示与术前相比肠道气体增多。
本病例强调了HFNC引起肠扩张的潜在风险，特别是在有食管裂孔疝等易感因素的患者中。虽然HFNC在气道管理中有效，但仔细的患者选择和技术优化至关重要。需要进一步研究以阐明HFNC对胃肠动力学的影响，并指导其在高危人群中的安全应用。
