Comparison of high flow nasal oxygen and standard nasal oxygen in preventing hypoxia in patients undergoing endoscopic retrograde cholangio pancreatography under sedation

Endoscopic retrograde cholangiopancreatography (ERCP) can be particularly challenging for anesthesiologists because of the increased difficulty in airway access when it is performed in the prone position, alongside typically older patients with increased comorbidities. This study aimed to compare the effectiveness of high-flow nasal oxygen (HFNO) versus standard nasal oxygen (NO) in preventing hypoxemia in patients undergoing deep sedation monitored by Bispectral Index (BIS) during ERCP procedures. This prospective clinical study included 187 patients. Patients were allocated to the NO or HFNO group. Frailty levels were evaluated using the Modified Frailty Index-11 (mFI-11) before the procedure. Sedation was adjusted to maintain BIS values between 60 and 80. The SpO2 levels at 5 and 10 min were higher in the HFNO group than in the NO group (p=0.002 and p=0.003, respectively). The changes in SpO2 over time differed significantly between the groups (F=7.315, p<0.001). The frequency of interventions, such as chin lift, increasing O2 flow, SpO2<90, and SpO2 75-90, was higher in the NO group than in the HFNO group (p<0.001, p=0.006, p=0.006, and p<0.001, respectively). Administration of HFNO under deep sedation to ERCP patients with a higher rate of comorbidities may prevent desaturation and provide safe anesthesia.