High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: Α systematic review and meta-analysis.

Doulberis, Michael; Sampsonas, Fotios; Papaefthymiou, Apostolis; Karamouzos, Vasileios; Lagadinou, Maria; Karampitsakos, Theodoros; Stratakos, Grigorios; Kuntzen, Thomas; Tzouvelekis, Argyrios (2022). High-flow versus conventional nasal cannula oxygen supplementation therapy and risk of hypoxia in gastrointestinal endoscopies: Α systematic review and meta-analysis. Expert review of respiratory medicine, 16(3), pp. 323-332. Taylor & Francis 10.1080/17476348.2022.2042256

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BACKGROUND AND AIMS

Gastrointestinal endoscopy (GIE) represents a mainstay diagnostic and therapeutic procedure in modern clinical practice. Hypoxemia and respiratory failure during endoscopy constitute major complications and concerns for endoscopists. Emerging evidence supports the utilization of high-flow nasal cannula (HFNC) over conventional nasal cannula (CNC) for oxygen supplementation and avoidance of hypoxemia. Aim of our study was to compare the risk of hypoxemia in patients undergoing GIE with HFNC versus CNC oxygen supplementation recruited by randomized controlled trials (RCTs).

METHODS

We conducted an electronic literature search in established medical databases i.e. PubMed, EMBASE and Cochrane to identify RCTs investigating the abovementioned association. The enrolled studies were evaluated for risk of bias and inserted into a random effects model for meta-analysis; sub-group analyses and publication bias were also assessed.

RESULTS

Out of 271 initially retrieved articles, five RCTs were eligible for meta-analysis with totally 2656 recruited patients (1299 HFNC and 1357 CNC). A statistically significant reduced relative risk (RR) of hypoxemia among HFNC patients was revealed (RR=0.18, CI95%: 0.05-0.61), whilst with high heterogeneity (I2:79.94%, p<0.01). Patients undergoing upper GIE with HFNC displayed a significantly lower risk of hypoxemia (96%, p<0.001, I2:15.59%), even after exclusion of endoscopic retrograde cholangiopancreatography (ERCP) cases (RR:0.03, CI95%: 0.01-0.21), albeit with higher heterogeneity (I2:41.82%). Contrariwise, colonoscopy with HFNC did not yield a statistically significant RR reduction (p=0.14).

CONCLUSION

Patients undergoing upper GIE with HFNC oxygen experience significantly less hypoxemia burden than CNC counterparts. Further research is warranted to establish this emerging association to target optimal safety during endoscopy.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
UniBE Contributor:	Doulberis, Michael
Subjects:	600 Technology > 610 Medicine & health
ISSN:	1747-6356
Publisher:	Taylor & Francis
Language:	English
Submitter:	Pubmed Import
Date Deposited:	08 Mar 2022 14:55
Last Modified:	05 Dec 2022 16:09
Publisher DOI:	10.1080/17476348.2022.2042256
PubMed ID:	35157538
Uncontrolled Keywords:	EGD ERCP HFNC colonoscopy digestive endoscopies gastrointestinal endoscopies high-flow high-flow nasal cannula hypercapnia hypoxemia
URI:	https://boris.unibe.ch/id/eprint/165809