Waheed Shahan, Kapadia Nazir Najeeb, Jawed Rida, Raheem Ahmed, Khan Muhammad Faisal
Department of Emergency Medicine, Aga Khan University and Hospital (AKUH), Karachi, Pakistan.
Department of Emergency Medicine, King Hamad University Hospital, Al Muharraq, Bahrain.
BMC Res Notes. 2025 Jul 1;18(1):264. doi: 10.1186/s13104-025-07328-7.
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.
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.
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.
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.
ClinicalTrials.gov Registry: NCT04242537 on 2020-01-27.
尽管窒息氧合已证明在延长插管期间的安全窒息时间方面有效，但在紧急情况下高流量鼻导管（HFNC）和低流量鼻导管（LFNC）之间的优越性比较仍未得到探索。这项随机对照试验评估了与不进行氧输送的标准护理相比，使用HFNC或LFNC并抬高头部进行窒息氧合是否能改善氧合和插管结果。
我们在一家三级护理急诊科进行了一项三臂随机试验，采用区组随机化（1:1:1）。需要插管的成年患者被随机分配接受通过HFNC（20 L/分钟）、LFNC（10 L/分钟）进行的窒息氧合或标准护理。主要结局是插管后3分钟时的最低氧饱和度，共同主要结局是首次通过成功率。次要结局包括安全窒息时间、插管后并发症（低血压、氧饱和度下降、心律失常）、喉镜视野以及辅助设备的需求。采用意向性分析。
我们的研究纳入了88例接受气管插管的患者，分为高流量组、低流量组和标准护理组。高流量组的中位SpO2最高，且与其他组相比变异性较小。标准组的首次尝试成功率最高（93%）。高流量组的窒息持续时间在统计学上显著短于低流量组。低流量组插管后低血压（46%）和氧饱和度下降（57%）的发生率较高。
与LFNC和标准护理相比，抬高头部定位的HFNC可降低插管后的氧饱和度下降和低血压。HFNC可能是紧急插管期间的有益辅助手段，尤其是对于有缺氧或血流动力学不稳定风险的患者。
ClinicalTrials.gov注册编号：NCT04242537，于2020年1月27日注册。
