Acute Crit Care.  2024 Feb;39(1):61-69. 10.4266/acc.2022.01543.

Comparison of preoxygenation with a high-flow nasal cannula and a simple face mask before intubation in Korean patients with head and neck cancer

• Jo JY
• Yoon J
• Jang H
• Kim WJ
• Ku S
• Choi SS

• KMID: 2555224
• DOI: http://doi.org/10.4266/acc.2022.01543

Abstract

Background
Although preoxygenation is an essential procedure for safe endotracheal intubation, in some cases securing sufficient time for tracheal intubation may not be possible. Patients with head and neck cancer might have a difficult airway and need a longer time for endotracheal intubation. We hypothesized that the extended apneic period with preoxygenation via a high-flow nasal cannula (HFNC) is beneficial to patients who undergo head and neck surgery compared with preoxygenation with a simple mask. Methods: The study was conducted as a single-center, single-blinded, prospective, randomized controlled trial. Patients were divided into groups based on one of the two preoxygenation methods: HFNC group or simple facemask (mask group). Preoxygenation was performed for 5 minutes with each method, and endotracheal intubation for all patients was performed using a video laryngoscope. Oxygen partial pressures of the arterial blood were compared at the predefined time points. Results: For the primary outcome, the mean arterial oxygen partial pressure (PaO2 ) immediately after intubation was 454.2 mm Hg (95% confidence interval [CI], 416.9–491.5 mm Hg) in the HFNC group and 370.7 mm Hg (95% CI, 333.7–407.4 mm Hg) in the mask group (P=0.002). The peak PaO2 at 5 minutes after preoxygenation was not statistically different between the groups (P=0.355). Conclusions: Preoxygenation with a HFNC extending to the apneic period before endotracheal intubation may be beneficial in patients with head and neck cancer.

Keyword

airway management; nasal cannula; preoxygenation

Figure

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  Figure 1. Consolidated Standards of Reporting Trials (CONSORT) flow diagram. HFNC: high-flow nasal cannula.

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  Figure 2. Data from arterial blood gas analysis. Values are presented as estimated mean±95% confidence interval. P-values for interactions between group and time for arterial oxygen partial pressure (PaO2; A), partial pressure of arterial carbon dioxide (PaCO2; B), and pH (C) were 0.008, 0.002, and 0.080, respectively. T0: preinduction baseline; T1: 2 minutes after preoxygenation; T2: 5 minutes after preoxygenation; T3: at the second tidal volume with mechanical ventilation after intubation; HFNC: high-flow nasal cannula. a) P<0.001 compared to baseline in each group; b) P<0.001 compared between groups.

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  Figure 3. Changes in vital signs during induction. Values are presented as estimated mean±95% confidence interval. P-values for interactions between group and time for systolic blood pressure (A), diastolic blood pressure (B), mean blood pressure (C), and heart rate (D) were 0.955, 0.641, 0.995, and 0.112, respectively. T0: preinduction baseline; T1: 2 minutes after preoxygenation; T2: 5 minutes after preoxygenation; T3: at the second tidal volume with mechanical ventilation after intubation; HFNC: high-flow nasal cannula. a) P<0.001 compared to baseline in each group.

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