Benefits of High-Flow Nasal Oxygen (HFNO) for Endoscopy
High-flow nasal oxygen significantly reduces the incidence of oxygen desaturation during endoscopic procedures compared to conventional oxygen therapy, making it the preferred option for patients at risk of hypoxemia during endoscopy. 1, 2
Key Benefits of HFNO During Endoscopy
Reduced Risk of Hypoxemia
- HFNO decreases the incidence of oxygen desaturation (SpO2 ≤92%) by approximately 23.4% compared to standard oxygen therapy during gastrointestinal endoscopy 1
- Complete prevention of hypoxia (75% ≤ SpO2 < 90%) and severe hypoxia (SpO2 < 75%) has been demonstrated in patients undergoing gastroscopy with propofol sedation 2
- Meta-analysis shows significantly fewer desaturation episodes with HFNO during upper GI endoscopic procedures (odds ratio = 0.23) 3
Improved Procedural Efficiency
- Reduced procedural interruptions due to oxygen desaturation (odds ratio = 0.11) 3
- Fewer requirements for airway maneuvers to maintain patency (11.1% vs 32.4%) 1
- No significant impact on the overall duration of endoscopic procedures 3
Physiological Advantages
- Delivers warm and humidified oxygen at high flow rates (up to 60 L/min) 4
- Provides modest positive end-expiratory pressure, improving pulmonary compliance 4
- Reduces anatomical dead space through washout effect 4
- Improves oxygenation with higher nadir SpO2 levels during procedures (mean difference = 3.16) 3
- Reduces work of breathing during the procedure 4
Patient Comfort and Safety
- HFNO reduces patient discomfort compared to other oxygen delivery methods 4
- Fewer overall sedation-related adverse events (odds ratio = 0.63) 3
- Minimal HFNO-related adverse events (primarily mild xeromycteria/rhinalgia in 1.7% of patients) 2
- Particularly beneficial for high-risk patients with airway stenosis, reducing desaturation occurrence (34.7% vs 61.4%) 5
Patient Populations Most Likely to Benefit
HFNO is especially valuable for patients with risk factors for hypoxemia during endoscopy, including:
- Patients over 60 years of age 1
- Those with underlying cardiac or respiratory disease 1
- Patients with ASA physical status >1 1
- Patients with obesity or sleep apnea syndrome 1, 6
- Those with airway stenosis or narrow trachea 5
- Patients with baseline hypoxemia and/or hypercapnia 5
Implementation Considerations
- HFNO can be set at flow rates between 30-60 L/min with FiO2 of 0.50 for optimal results during endoscopy 1, 2
- For high-risk bronchoscopy patients, HFNO significantly reduces the need for treatment escalation (30.6% vs 57.1%) 5
- While HFNO equipment may have higher initial costs than conventional oxygen therapy, the reduction in procedural complications and interruptions may offset these costs 4