Skip to content
DraconiticResearch
Search Sources API
184,584 studies31 sourcesUpdated 35 min ago
Peer-reviewedCC BY 4.0Journal of Clinical Medicine

High-Flow Nasal Oxygenation Is Associated with Improved Respiratory Stability During Moderate Multimodal Analgosedation for Pars Plana Vitrectomy: A Randomized Controlled Trial

  • Anita Vuković1
  • Tomislav Jukić2
  • Marija Štanfel2
  • Krešimir Mandić2
  • Slobodan Mihaljević3
  • Dubravka Bartolek-Hamp3
  1. 1Department of Anesthesiology, Reanimatology and Intensive Care Unit, General Hospital Dubrovnik, 20000 Dubrovnik, Croatia
  2. 2Clinic of Ophthalmology, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
  3. 3Clinic of Anesthesiology, Reanimatology and Intensive Care Unit, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
Read full textPDFDOICite

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.

Related

  1. Comparison of sevoflurane and propofol on the novel oxygenation index and respiratory mechanics in gynecological laparoscopic surgery: a randomized controlled trial
    Meining Zhang, Shiwei Huang, Shaodan Xu +6
    Scientific ReportsPeer-reviewedCC BY-NC-ND 4.0Full textSurgery & anaesthesiaCrossref
  2. "White-Out Lung" Following Veno-Venous Extracorporeal Membrane Oxygenation (ECMO) Initiation for Acute Refractory Respiratory Failure From Obstructive Lung Disease: A Case Series.
    Santhalakshmi Angappan, Joseph Brisson, Nakul S Kumar
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  3. Solving a Physiological Conundrum: Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) as a Bridge Strategy in Severe Acute Respiratory Distress Syndrome (ARDS) Complicated by High-Output Bronchopleural Fistula.
    Inês L Freitas, Joana S Braga, Ana R Branco +2
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  4. Comparative Performance of Oxygenation Indices for Mortality Prediction in Patients With Acute Respiratory Distress Syndrome at a Tertiary Care Intensive Care Unit in Bangladesh.
    Jannatun Naim, Nafiza Afroz, Most Nasrin Sultana +2
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMCPMC
  5. Sequential Associations of Sleep Architecture, Nocturnal Oxygenation, and Respiratory Disturbance With a Composite PSG-Derived Rhythm-Event Index.
    Nasim Nikoubakht, Fatemeh Kashaninasab, Mir Farhad Ghalehbandi +2
    Brain and behaviorPeer-reviewedCC BYFull textPhysiologyEurope PMCPMC

Cite

BibTeXRIS
BibTeX
@article{vukovic2026highflow,
  title = {{High-Flow Nasal Oxygenation Is Associated with Improved Respiratory Stability During Moderate Multimodal Analgosedation for Pars Plana Vitrectomy: A Randomized Controlled Trial}},
  author = {Anita Vuković and Tomislav Jukić and Marija Štanfel and Krešimir Mandić and Slobodan Mihaljević and Dubravka Bartolek-Hamp},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207972},
  url = {https://www.mdpi.com/2077-0383/15/20/7972},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - High-Flow Nasal Oxygenation Is Associated with Improved Respiratory Stability During Moderate Multimodal Analgosedation for Pars Plana Vitrectomy: A Randomized Controlled Trial
AU  - Anita Vuković
AU  - Tomislav Jukić
AU  - Marija Štanfel
AU  - Krešimir Mandić
AU  - Slobodan Mihaljević
AU  - Dubravka Bartolek-Hamp
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207972
UR  - https://www.mdpi.com/2077-0383/15/20/7972
AB  - 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.
SN  - 2077-0383
ER  -