Use of Optiflow THRIVE High-Flow Nasal Oxygen System versus a Non-rebreather Oxygen Delivery Device in Patients with Increased Risks of Airway Obstruction in Interventional Radiology Procedures: A Randomized Pilot Study

Background The room configuration in interventional radiology procedures hinders simultaneous access to the patient’s airway and anesthesia machines, and this issue may lead to suboptimal sedation levels in patients with increased risks of airway obstruction owing to patient safety concern. We conducted a randomized trial to evaluate the effectiveness of using a high-flow nasal oxygen (HFNO) device (F&P Optiflow™) versus a standard non-rebreather oxygen delivery device to reduce airway obstruction and improve patient outcomes during anesthesia among patients with increased risks of airway obstruction. Methods Patients at increased risks of airway obstruction were randomized to receive 100% oxygen at a rate of either 70 L/min (HFNO group) or 8 L/min (standard-of-care [SoC] group) along with a continuous intravenous propofol infusion to achieve unconsciousness. We evaluated the total length of desaturation episodes [ToLDE] defined as oxygen saturation [SpO ₂ ] ≤92%, the number of desaturation episodes, and the time spent in the postanesthesia care unit (PACU). The level of sedation was assessed using the number of bispectral index (BIS) episodes (defined as episodes of BIS value ≥ 61), and patients’ PACU self-reported symptoms. Results The study included 101 patients, 50 in the HFNO group and 51 in the SoC group. The mean ToLDE time was 0.34 minutes (median, 0; range 0-6.5 minutes) in the HFNO group and 0.97 minutes (median, 0; range 0-19.8 minutes) in the SoC group ( P  = 0.158). The proportion of patients experiencing at least one desaturation episode was 14% in the HFNO group and 26% in the SoC group ( P  = 0.212). The median total number of BIS episodes was higher in the SoC group (4; range, 0–19) than the HFNO group (2; range, 0–15; P  = 0.005). Median PACU stay was 20 minutes (range, 0–60) in the HFNO group and 26 minutes (range, 5–60) in the SOC group ( P  = 0.076). Six of 50 patients (12%) in the HFNO group and 8 of 51 (16%) in the SoC group reported PACU complaints and the complaints were less severe in the HFNO group. Conclusions HFNO was not superior to a standard non-rebreather oxygen delivery device in preventing hypoxic events among patients with increased risks of airway obstruction undergoing moderate to deep sedation. However, HFNO may reduce the need for airway interventions and improve the overall patient experience and thus warrants further investigation. Trial registration: ClinicalTrials.gov ID: NCT04171037; Date of original registration: November 19, 2019; This study was retrospectively registered. Study principal investigator: Gang Zheng; This manuscript adheres to the applicable Consolidated Standards of Reporting Trials (CONSORT) guidelines.