BMJ

High flow beats standard nasal cannula oxygen for obese patients undergoing GI endoscopy

February 24, 2025

In patients with obesity, oxygenation via high flow nasal cannula (HFNC) during sedated gastrointestinal endoscopy significantly reduced the incidences of hypoxia, subclinical respiratory depression, and severe hypoxia, without increasing other adverse events.

Study details: This multicenter, randomized, parallel group trial conducted at three tertiary hospitals in Shanghai, China, included 1,000 adult patients with obesity (BMI ≥28) who were scheduled for gastrointestinal endoscopy. Participants were randomly allocated to receive regular nasal cannula oxygenation or HFNC oxygenation during a sedated procedure with propofol and low dose sufentanil.

Results: From May 6, 2021, to May 26, 2023, 984 patients (mean age 49.2 years; 36.9% female) completed the study. Compared with regular nasal cannula oxygenation, HFNC oxygenation reduced the incidence of hypoxia from 21.2% (103/487) to 2.0% (10/497) (difference −19.14, 95% confidence interval [CI], −23.09 to −15.36; P < 0.001), subclinical respiratory depression from 36.3% (177/487) to 5.6% (28/497) (difference −30.71, CI, −35.40 to −25.92; P < 0.001), and severe hypoxia from 4.1% (20/487) to 0% (0/497) (difference −4.11%, CI, −6.26 to −2.48; P < 0.001). Other sedation-related adverse events didn't differ between the 2 groups.

Source:

Wang L, Zhang Y, Han D, Wei M, Zhang J, Cheng X, et al. (2025, February 11). Effect of high flow nasal cannula oxygenation on incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity: multicentre randomised controlled trial. BMJ 2025; 388 :e080795 doi:10.1136/bmj-2024-080795 https://www.bmj.com/content/388/bmj-2024-080795