PMID- 35027169
OWN - NLM
STAT- MEDLINE
DCOM- 20230103
LR  - 20230127
IS  - 1471-6771 (Electronic)
IS  - 0007-0912 (Print)
IS  - 0007-0912 (Linking)
VI  - 130
IP  - 1
DP  - 2023 Jan
TI  - Apnoeic oxygenation in morbid obesity: a randomised controlled trial comparing 
      facemask and high-flow nasal oxygen delivery.
PG  - 103-110
LID - S0007-0912(21)00800-X [pii]
LID - 10.1016/j.bja.2021.12.011 [doi]
AB  - BACKGROUND: Obesity is a risk factor for airway-related incidents during 
      anaesthesia. High-flow nasal oxygen has been advocated to improve safety in 
      high-risk groups, but its effectiveness in the obese population is uncertain. 
      This study compared the effect of high-flow nasal oxygen and low-flow facemask 
      oxygen delivery on duration of apnoea in morbidly obese patients. METHODS: 
      Morbidly obese patients undergoing bariatric surgery were randomly allocated to 
      receive either high-flow nasal (70 L min(-1)) or facemask (15 L min(-1)) oxygen. 
      After induction of anaesthesia, the patients were apnoeic for 18 min or until 
      peripheral oxygen saturation decreased to 92%. RESULTS: Eighty patients were 
      studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 
      min in both the High-Flow Nasal Oxygen (IQR 18-18 min) and the Facemask 
      (inter-quartile range [IQR], 4.1-18 min) groups. Five patients in the High-Flow 
      Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% 
      within 18 min. The risk of desaturation was significantly lower in the High-Flow 
      Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11-0.65; 
      P=0.007). CONCLUSIONS: In experienced hands, apnoeic oxygenation is possible in 
      morbidly obese patients, and oxygen desaturation did not occur for 18 min in the 
      majority of patients, whether oxygen delivery was high-flow nasal or low-flow 
      facemask. High-flow nasal oxygen may reduce desaturation risk compared with 
      facemask oxygen. Desaturation risk is a more clinically relevant outcome than 
      duration of apnoea. Individual physiological factors are likely to be the primary 
      determinant of risk rather than method of oxygen delivery. CLINICAL TRIAL 
      REGISTRATION: NCT03428256.
CI  - Copyright (c) 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Schutzer-Weissmann, John
AU  - Schutzer-Weissmann J
AD  - Imperial College Healthcare NHS Trust, London, UK; The Royal Marsden Hospital NHS 
      Foundation Trust, London, UK. Electronic address: j.weissmann@nhs.net.
FAU - Wojcikiewicz, Thomas
AU  - Wojcikiewicz T
AD  - Imperial College Healthcare NHS Trust, London, UK; Royal Surrey NHS Foundation 
      Trust, Guildford, UK.
FAU - Karmali, Anil
AU  - Karmali A
AD  - Imperial College Healthcare NHS Trust, London, UK; London North West University 
      Healthcare NHS Trust, Harrow, UK.
FAU - Lukosiute, Asta
AU  - Lukosiute A
AD  - Imperial College Healthcare NHS Trust, London, UK; Guy's and St Thomas' NHS 
      Foundation Trust, London, UK.
FAU - Sun, Ruoyi
AU  - Sun R
AD  - Imperial College Healthcare NHS Trust, London, UK.
FAU - Kanji, Rafiq
AU  - Kanji R
AD  - Imperial College Healthcare NHS Trust, London, UK; Guy's and St Thomas' NHS 
      Foundation Trust, London, UK.
FAU - Ahmed, Ahmed R
AU  - Ahmed AR
AD  - Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and 
      Cancer, Imperial College London, UK.
FAU - Purkayastha, Sanjay
AU  - Purkayastha S
AD  - Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and 
      Cancer, Imperial College London, UK.
FAU - Brett, Stephen J
AU  - Brett SJ
AD  - Imperial College Healthcare NHS Trust, London, UK; Department of Surgery and 
      Cancer, Imperial College London, UK.
FAU - Cousins, Jonathan
AU  - Cousins J
AD  - Imperial College Healthcare NHS Trust, London, UK.
LA  - eng
SI  - ClinicalTrials.gov/NCT03428256
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20220111
PL  - England
TA  - Br J Anaesth
JT  - British journal of anaesthesia
JID - 0372541
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Humans
MH  - *Masks/adverse effects
MH  - *Obesity, Morbid/therapy/complications
MH  - Apnea/therapy
MH  - Administration, Intranasal
MH  - Oxygen
MH  - Oxygen Inhalation Therapy/adverse effects
PMC - PMC9875910
OTO - NOTNLM
OT  - THRIVE
OT  - apnoeic oxygenation
OT  - apnoeic ventilation
OT  - bariatric anaesthesia
OT  - desaturation risk
OT  - high-flow nasal oxygen
OT  - obesity
OT  - safe apnoea time
EDAT- 2022/01/15 06:00
MHDA- 2023/01/04 06:00
PMCR- 2022/01/11
CRDT- 2022/01/14 05:36
PHST- 2021/07/19 00:00 [received]
PHST- 2021/11/26 00:00 [revised]
PHST- 2021/12/08 00:00 [accepted]
PHST- 2022/01/15 06:00 [pubmed]
PHST- 2023/01/04 06:00 [medline]
PHST- 2022/01/14 05:36 [entrez]
PHST- 2022/01/11 00:00 [pmc-release]
AID - S0007-0912(21)00800-X [pii]
AID - 10.1016/j.bja.2021.12.011 [doi]
PST - ppublish
SO  - Br J Anaesth. 2023 Jan;130(1):103-110. doi: 10.1016/j.bja.2021.12.011. Epub 2022 
      Jan 11.