Zhao Kuangyu, Li Yanhong, Wang Qian, Zhang Jiaqiang, Zhou Jun
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, No.7, Wei Wu Road, Jinshui District, Zhengzhou City, Henan Province, 450000, China.
BMC Anesthesiol. 2025 Aug 27;25(1):428. doi: 10.1186/s12871-025-03214-8.
Hypoxia is the leading cause of complications and death during anesthesia. The risk of hypoxemia in children is higher than in adults. The use of high-flow nasal cannula (HFNC) can prevent desaturation of blood oxygen saturation in children. This meta-analysis aimed to compare the effectiveness of HFNC and conventional oxygenation methods in reducing perioperative desaturation in pediatric patients.
The standard database was searched from the beginning till April 2024. Studies including perioperative use of HFNC had at least one of the following five outcomes: (1) incidence of desaturation, (2) minimum O saturation, (3) safe apnea time, (4) terminal transcutaneous Carbon dioxide (TcCO), and (5) additional interventions. The perioperative period is divided into three stages: general anesthesia induction, intraoperative sedation, and postoperative extubation.
This meta-analysis included eight randomized controlled trials (one induction, five surgeries, two extubations; 653 patients total). Compared to conventional oxygen therapy, HFNC had a perioperative desaturation relative risk of 0.42 (95% CI: 0.18, 0.98; = ) and improved minimum oxygen saturation with a mean difference of 5.58 (95% CI: 1.27, 9.89; = ). Notably, the HFNC group had a relative risk of 0.44 (95% CI: 0.27, 0.69; = ) for requiring special interventions. However, no significant differences were observed between groups in safe apnea time (mean difference 0.78, 95% CI: -4.73, 6.29; = ) or final transcutaneous carbon dioxide (TcCO) levels (mean difference -0.74, 95% CI: -2.88, 1.40; = ).
Compared with conventional oxygenation, HFNC use is associated with a lower risk of desaturation, higher minimum O saturation, and reduced need for additional interventions, while maintaining comparable safe apnea time and CO levels during perioperative application. These findings suggest that HFNC may be a valuable tool for pediatric patients with anticipated difficult intubation, apnea-prone airway surgery, or postoperative extubation challenges. However, the results should be interpreted with caution due to limitations, including the small number of included studies, heterogeneity in clinical settings (e.g., anesthesia phases and surgical types), and potential variability in outcome definitions. Further large-scale trials are needed to confirm these findings, particularly in high-risk subgroups and various perioperative contexts.
CRD42024545348.
The online version contains supplementary material available at 10.1186/s12871-025-03214-8.
缺氧是麻醉期间并发症和死亡的主要原因。儿童低氧血症的风险高于成人。使用高流量鼻导管（HFNC）可预防儿童血氧饱和度下降。本荟萃分析旨在比较HFNC与传统氧疗方法在降低儿科患者围手术期血氧饱和度下降方面的有效性。
检索标准数据库至2024年4月。纳入围手术期使用HFNC的研究至少有以下五项结果之一：（1）血氧饱和度下降发生率，（2）最低氧饱和度，（3）安全呼吸暂停时间，（4）终末经皮二氧化碳（TcCO），以及（5）额外干预措施。围手术期分为三个阶段：全身麻醉诱导、术中镇静和术后拔管。
本荟萃分析纳入了八项随机对照试验（一项诱导、五项手术、两项拔管；共653例患者）。与传统氧疗相比，HFNC围手术期血氧饱和度下降的相对风险为0.42（95%CI：0.18，0.98；P = ），最低氧饱和度提高，平均差值为5.58（95%CI：1.27，9.89；P = ）。值得注意的是，HFNC组需要特殊干预的相对风险为0.44（95%CI：0.27，0.69；P = ）。然而，两组在安全呼吸暂停时间（平均差值0.78，95%CI：-4.73，6.29；P = ）或终末经皮二氧化碳（TcCO）水平（平均差值-0.74，95%CI：-2.88，1.40；P = ）方面未观察到显著差异。
与传统氧疗相比，使用HFNC与更低的血氧饱和度下降风险、更高的最低氧饱和度以及减少额外干预需求相关，同时在围手术期应用中保持相当的安全呼吸暂停时间和二氧化碳水平。这些发现表明，对于预计有困难插管、易发生呼吸暂停的气道手术或术后拔管挑战的儿科患者，HFNC可能是一种有价值的工具。然而，由于存在局限性，包括纳入研究数量少、临床环境（如麻醉阶段和手术类型）的异质性以及结果定义的潜在变异性，结果应谨慎解释。需要进一步的大规模试验来证实这些发现，特别是在高危亚组和各种围手术期情况下。
CRD42024545348。
在线版本包含可在10.1186/s12871-025-03214-8获取的补充材料。
