• Aaron Conway, Peter Collins, Kristina Chang, Navpreet Kamboj, Ana Lopez Filici, Phoebe Lam, and Matteo Parotto.
• From the Peter Munk Cardiac Centre, University Health Network (AC, PC, KC), Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada (AC, NK), School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia (AC), Department of Anesthesia and Pain Management, UHN (ALF, PL, MP), Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada (MP).
• Eur J Anaesthesiol. 2021 Aug 1; 38 (8): 839849839-849.

BackgroundHigh flow nasal oxygen may better support the vulnerable respiratory state of patients during procedural sedation.ObjectiveThe objective of this study was to investigate the effects of high flow nasal oxygen in comparison to facemask oxygen on ventilation during cardiac implantable electronic device procedures performed with procedural sedation.DesignA randomised controlled trial.SettingThe study was conducted at one academic hospital in Canada.ParticipantsAdults undergoing elective cardiac implantable electronic device procedures with sedation administered by an anaesthesia assistant, supervised by an anaesthesiologist from August 2019 to March 2020.InterventionsParticipants were randomised 1 : 1 to facemask (≥ 8 l · min-1) or high flow nasal oxygen (50 l · min-1 and a 50 : 50 oxygen to air ratio).Main Outcome MeasuresThe primary outcome was peak transcutaneous carbon dioxide. Outcomes were analysed using Bayesian statistics.ResultsThe 129 participants who were randomised and received sedation were included. The difference in peak transcutaneous carbon dioxide was 0.0 kPa (95% CI -0.17 to 0.18). Minor adverse sedation events were 6.4 times more likely to occur in the high flow nasal oxygen group. This estimate is imprecise (95% CI 1.34 to 42.99). The odds ratio for oxygen desaturation for the high flow nasal oxygen group compared with the facemask group was 1.2 (95% CI 0.37 to 3.75). The difference in satisfaction with sedation scores between groups was 0.0 (95% CI -0.33 to 0.23).ConclusionsVentilation, as measured by TcCO2, is highly unlikely to differ by a clinically important amount between high flow nasal oxygen at 50 l min-1 or facemask oxygen at 8 l min-1. Further research with a larger sample size would be required to determine the optimal oxygen:air ratio when using high flow nasal oxygen during cardiac implantable electronic device procedures performed with sedation.Trial Registration NumberNCT03858257.Copyright © 2021 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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