High-flow nasal oxygen therapy is a suitable alternative to maintain oxygenation in children undergoing upper airway surgery.
- High flow nasal oxygen therapy allows oxygen to be delivered at much higher rates through small nasal prongs.
- In a recent study, high-flow oxygen administration during anesthesia for tubeless airway surgery was uninterrupted and successful in 89% of cases, compared with 88% of cases with standard care.
- There were no differences in adverse events between the intervention groups. Thus, high-flow nasal oxygen therapy and standard care appear equally safe.
Tubeless upper airway surgery in children is a complex procedure in which surgeons and anesthesiologists share the same operating field. “Microlaryngoscopy, in which the surgeon inspects the upper and lower airways for abnormalities, requires the anesthesiologist to use a tubeless method of oxygen delivery to allow a complete, unobstructed view of the entire airway. Young patients are therefore at risk of low oxygen levels during this procedure. As a result, the operation often has to be interrupted to increase oxygenation,” said Susan Humphreys, professor at the University of Queensland’s Centre for Child Health Research in Australia, and Andreas Schibler of the Wesley Research Institute in Queensland.
Surgery: Children given oxygen at much higher levels
In a new study, published in the journal The Lancet Respiratory Medicinethe researcher and his team wanted to know if high-flow nasal oxygen therapy was effective in reducing the frequency of interruptions in rescue oxygen therapy in children undergoing upper airway surgery. As a reminder, this method administers oxygen at much higher rates through small nasal prongs throughout the respiratory cycle when the patient’s mouth is closed. To carry out their work, the scientists conducted tests in five Australian hospitals with anaesthetists and ear, nose and throat surgeons. In detail, they recruited 497 children under the age of 16 who were scheduled to undergo tubeless upper airway surgery. Some received high-flow nasal oxygen therapy, while the others received standard oxygen therapy (oxygen flows of up to 6 L/min).
High-flow nasal oxygen therapy, a safe and effective alternative in children
According to the results, 236 of 267 procedures under high-flow oxygen were successful without interruption during tubeless airway surgery, compared with 229 of 261 procedures under standard care. There were 51 procedures with a hypoxemic event (i.e., lack of oxygen supply) in the high-flow oxygen group and 57 in the standard care group. Adverse events reported in both groups were epistaxis (nosebleed), laryngospasm (vocal cord spasm), bronchospasm (sudden contraction of bronchial smooth muscle), bradycardia (abnormally slow heart rate), cardiac arrest, hypotension, or death.
“High-flow nasal oxygen therapy during tubeless upper airway surgery did not reduce the proportion of procedure interruptions for rescue oxygen compared with standard care. However, the study shows that it provides anesthesiologists with a second option when deciding how best to administer oxygen to children undergoing this type of surgery,” concluded the authors.
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