Key result
High-flow nasal oxygen did not significantly improve the change in arterial oxygenation compared with standard oxygen therapy during transcatheter aortic valve replacement under conscious sedation (p=0.087).
Why the study?
Transfemoral transcatheter aortic valve replacement is increasingly performed under conscious sedation with supplementary oxygen, but hypoxia and agitation are commonly observed.
Does high-flow nasal oxygen improve arterial oxygenation compared to standard oxygen therapy in patients undergoing TAVR with conscious sedation?
RCT (n=72)
Single-blind
1:1 ratio using online randomisation
No
Does high-flow nasal oxygen improve arterial oxygenation compared to standard oxygen therapy in patients undergoing TAVR with conscious sedation?
Absolute Event Rate: 1.6% vs -1.3%
p-value: p=0.087
High-flow nasal oxygen 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.
BackgroundMinimally 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 hours. This procedure is increasingly being performed under conscious sedation with supplementary oxygen, but hypoxia and agitation are commonly observed.MethodsIn 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. The primary endpoint was the change in arterial partial pressure of oxygen (PaO2) during the procedure. Secondary outcomes included the incidence of oxygen desaturation and patient movements. Results A total of 72 patients were recruited. There was no difference in change in PaO2 from baseline using high-flow compared with standard oxygen therapy: median [IQR] increase from 12.1 (10.0- 15.3 [7.2- 29.8]) to 13.7 (10.8- 18.7 [8.5- 32.3]) kPa vs. decrease from 15.5 (12.4- 19.4 [9.2- 22.8]) to 14.2 (11.9- 19.3 [9.7- 22.8]) kPa, respectively (p= 0.087). There was a lower incidence of oxygen desaturation in the high-flow group (p= 0.037). Patients in the high-flow group moved less frequently (p= 0.006) and assigned a significantly higher comfort score to their treatment (p= < 0.001). ConclusionThis 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 registrationInternational Standard Randomised Controlled Trial Number (ISRCTN) 13804861. Registered 15/4/2019. https://doi.org/10.1186/ISRCTN13804861
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Scheuermann-Jahn et al. (2021) conducted an RCT in Severe aortic stenosis requiring transcatheter aortic valve replacement (TAVR) (n=72). High-flow nasal oxygen (HFNT) vs. Standard oxygen therapy (2 l.min-1 oxygen via standard nasal cannulae, FiO2 0.3) was evaluated on Change in arterial partial pressure of oxygen (PaO2) during the procedure (between first and second arterial blood gas measurements 30 minutes apart) (p=0.087). High-flow nasal oxygen did not significantly improve the change in arterial oxygenation compared with standard oxygen therapy during transcatheter aortic valve replacement under conscious sedation (p=0.087).
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