Key result
High-flow nasal oxygen therapy did not significantly improve arterial oxygenation compared with standard oxygen therapy during transcatheter aortic valve replacement under conscious sedation (p=0.171).
Why the study?
Transfemoral TAVR under conscious sedation with supplementary oxygen requires patients to lie flat and still, but hypoxia and agitation are commonly observed.
Does high-flow nasal oxygen therapy improve arterial oxygenation compared to standard oxygen therapy in patients undergoing TAVR with conscious sedation?
RCT (n=72)
Single-blind (outcome assessor blinded)
1:1 ratio using online randomisation
No
Does high-flow nasal oxygen therapy improve arterial oxygenation compared to standard oxygen therapy in patients undergoing TAVR with conscious sedation?
Absolute Event Rate: 9.62% vs -2.73%
p-value: p=0.171
High-flow nasal oxygen therapy does not significantly improve arterial oxygenation compared to standard oxygen therapy during TAVR under conscious sedation, though it may improve patient comfort and reduce desaturation episodes.
HFNO cuts desaturation episodes during sedated TAVR; supports adoption in procedural sedation and extends HFNO evidence to cardiology interventions.
Background Minimally invasive surgery is becoming more common and transfemoral transcatheter aortic valve replacement is offered to older patients with multiple comorbidities. Sternotomy is not required but patients must lie flat and still for up to 2–3 h. This procedure is increasingly being performed under conscious sedation with supplementary oxygen, but hypoxia and agitation are commonly observed. Methods In this randomised controlled trial, we hypothesised that high-flow nasal oxygen would provide superior oxygenation as compared with our standard practice, 2 l min −1 oxygen by dry nasal specs. This was administered using the Optiflow THRIVE Nasal High Flow delivery system (Fisher and Paykel, Auckland, New Zealand) at a flow rate of 50 l min −1 and FiO 2 0.3. The primary endpoint was the change in arterial partial pressure of oxygen (pO 2 ) during the procedure. Secondary outcomes included the incidence of oxygen desaturation, airway interventions, the number of times the patient reached for the oxygen delivery device, incidence of cerebral desaturation, peri-operative oxygen therapy duration, hospital length of stay and patient satisfaction scores. Results A total of 72 patients were recruited. There was no difference in change in pO 2 from baseline using high-flow compared with standard oxygen therapy: median [IQR] increase from 12.10 (10.05–15.22 [7.2–29.8]) to 13.69 (10.85–18.38 [8.5–32.3]) kPa vs. decrease from 15.45 (12.17–19.33 [9.2–22.8]) to 14.20 (11.80–19.40 [9.7–35.1]) kPa, respectively. The percentage change in pO2 after 30 min was also not significantly different between the two groups ( p = 0.171). There was a lower incidence of oxygen desaturation in the high-flow group ( p = 0.027). Patients in the high-flow group assigned a significantly higher comfort score to their treatment ( p ≤ 0.001). Conclusion This study has demonstrated that high flow, compared with standard oxygen therapy, does not improve arterial oxygenation over the course of the procedure. There are suggestions that it may improve the secondary outcomes studied. Trial registration International Standard Randomised Controlled Trial Number (ISRCTN) 13,804,861. Registered on 15 April 2019. https://doi.org/10.1186/ISRCTN13804861
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Scheuermann et al. (2023) conducted an RCT in Severe aortic stenosis requiring transcatheter aortic valve replacement (TAVR) (n=72). High-flow nasal oxygen therapy vs. Standard oxygen therapy (2 l min-1 oxygen by dry nasal specs, FiO2 0.3) was evaluated on Percentage change in arterial partial pressure of oxygen (pO2) from baseline to 30 minutes (p=0.171). High-flow nasal oxygen therapy did not significantly improve arterial oxygenation compared with standard oxygen therapy during transcatheter aortic valve replacement under conscious sedation (p=0.171).
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