{
  "abstract": "Background/Objectives: High-flow nasal oxygenation (HFNO) may improve respiratory stability during procedural sedation, but treatment-associated differences across patient risk categories remain uncertain. We compared HFNO with low-flow nasal oxygenation (LFNO) during moderate multimodal analgosedation (MMAS) for pars plana vitrectomy (PPV) in patients with ASA physical status I–III. Methods: In this prospective, single-center randomized trial, 164 adults undergoing elective PPV under regional eye anesthesia with MMAS were randomized to HFNO (40 L·min−1, set FiO2 0.40) or LFNO (5 L·min−1, intended to approximate a nominal FiO2 of 0.40). Sedation depth was monitored using the Patient State Index and evaluated using the Ramsay Sedation Scale. The primary outcome was maintenance of target oxygenation (SpO2 94–98%) without hypoxemia (SpO2 < 90%), assessed by peripheral oxygen saturation (SpO2) at three predefined time points (T0, T1, and T2). Secondary outcomes included breathing frequency (BF), measured end-tidal CO2 (EtCO2), and clinically significant bradypnea (CSB), defined as ≥1 bradypnea episode (BF < 12 breaths·min−1 persisting ≥1 min) accompanied by SpO2 90–93%, EtCO2 > 45 mmHg, or both. Results: The primary outcome showed no between-group difference. No hypoxemia (SpO2 < 90%) occurred. Oxygenation below the target range (SpO2 90–93%) was less frequent with HFNO peri-procedurally (adjusted RR, 0.14; 95% CI, 0.03–0.56; p = 0.006) and post-procedurally (adjusted RR, 0.15; 95% CI, 0.04–0.64; p = 0.010). Significant treatment × ASA interactions were observed for BF and measured EtCO2 peri-procedurally. In exploratory ASA-stratified analyses, ASA III patients receiving HFNO had higher BF, fewer CSB episodes, and lower measured EtCO2 than those receiving LFNO. Conclusions: HFNO was associated with improved respiratory stability compared with LFNO, with treatment-associated differences varying across ASA strata.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology, Reanimatology and Intensive Care Unit, General Hospital Dubrovnik, 20000 Dubrovnik, Croatia",
    "Clinic of Ophthalmology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia",
    "Clinic of Anesthesiology, Reanimatology and Intensive Care Unit, University Hospital Centre Zagreb, 10000 Zagreb, Croatia"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Anita Vuković"
    },
    {
      "affs": [
        1
      ],
      "name": "Tomislav Jukić"
    },
    {
      "affs": [
        1
      ],
      "name": "Marija Štanfel"
    },
    {
      "affs": [
        1
      ],
      "name": "Krešimir Mandić"
    },
    {
      "affs": [
        2
      ],
      "name": "Slobodan Mihaljević"
    },
    {
      "affs": [
        2
      ],
      "name": "Dubravka Bartolek-Hamp",
      "orcid": "0000-0001-8909-6747"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/6b0j3pt4mcbe4.bib",
  "cited_by": 0,
  "doi": "10.3390/jcm15207972",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706019/?tool=EBI",
  "id": "6b0j3pt4mcbe4",
  "issns": [
    "2077-0383"
  ],
  "landing_url": "https://www.mdpi.com/2077-0383/15/20/7972",
  "language": "eng",
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2703|Anesthesia and Sedative Agents"
    ]
  ],
  "openalex": "W7222079448",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13706019/pdf/?tool=EBI",
  "pmcid": "PMC13706019",
  "pmid": null,
  "published": "2026-10-01",
  "publisher": "MDPI AG",
  "ris": "https://research.draconitic.com/paper/6b0j3pt4mcbe4.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:20:00Z",
      "native_id": "10.3390/jcm15207972",
      "source": "crossref",
      "url": "https://www.mdpi.com/2077-0383/15/20/7972"
    },
    {
      "first_seen": "2026-10-30T12:21:40Z",
      "native_id": "PMC:PMC13706019",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13706019"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2703|Anesthesia and Sedative Agents",
      "subfield": "surgery"
    }
  ],
  "title": "High-Flow Nasal Oxygenation Is Associated with Improved Respiratory Stability During Moderate Multimodal Analgosedation for Pars Plana Vitrectomy: A Randomized Controlled Trial",
  "title_text": "High-Flow Nasal Oxygenation Is Associated with Improved Respiratory Stability During Moderate Multimodal Analgosedation for Pars Plana Vitrectomy: A Randomized Controlled Trial",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:21:40Z",
  "url": "https://research.draconitic.com/paper/6b0j3pt4mcbe4",
  "venue": "Journal of Clinical Medicine",
  "versions": []
}