Abstract Background Hypoxia is common among mitral regurgitation patients and may be more susceptible to anesthetics. To evaluate the security and efficacy of high flow nasal cannula oxygen therapy (HFNC) and nasal cannula for sedated transesophageal echocardiography (TEE) in patients with mitral regurgitation. Methods 226 patients scheduled to receive TEE under sedation were randomized into two groups: HFNC group (Group H) and nasal cannula group (Group C). The incidence of hypoxia during the TEE procedure was the main result. Secondary outcomes included hypoxia-related measures and interventions, ventilation and adverse events related to sedation. Results In comparison to Group C, Group H exhibited a significant decrease in the incidences of hypoxia and severe hypoxia, dropping from 26.3–15.0% (P < 0.05) and 1.8–0% (P < 0.05), respectively. Conclusion Compared with nasal cannula, HFNC can reduce hypoxia during TEE procedure in patients with mitral regurgitation. Trial registration ChiCTR2300068412, 17/02/2023.
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