Supraglottic jet oxygenation and ventilation enhances oxygenation during upper gastrointestinal endoscopy in patients sedated with propofol: a randomized multicentre clinical trial

• Published in: British journal of anaesthesia : BJA Vol. 119; no. 1; pp. 158 - 166
• Main Authors: Qin, Y., Li, L.Z., Zhang, X.Q., Wei, Y., Wang, Y.L., Wei, H.F., Wang, X.R., Yu, W.F., Su, D.S.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-07-2017; Oxford University Press
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Endoscopy, Gastrointestinal; Female; gastroscopy; High-Frequency Jet Ventilation - instrumentation; High-Frequency Jet Ventilation - methods; Humans; Hypnotics and Sedatives - pharmacology; hypoxia; Hypoxia - prevention & control; Male; Middle Aged; Oxygen - metabolism; Propofol - pharmacology; Prospective Studies; Single-Blind Method; Young Adult; gastroscopy; hypoxia
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aex091

Hypoventilation is the main reason for hypoxia during upper gastrointestinal endoscopy procedures with sedation. The key to preventing hypoxia is to maintain normal ventilation during the procedure. We introduced supraglottic jet oxygenation and ventilation (SJOV) through a new Wei nasal jet tube (WNJ) to reduce the incidence of hypoxia in patients sedated with propofol during upper gastrointestinal endoscopy procedures.
In a multicentre, prospective randomized single-blinded study, 1781 outpatients undergoing routine upper gastrointestinal endoscopy who were sedated with propofol by an anaesthetist were randomized into the following three groups: the supplementary oxygen via nasal cannula group [nasal cannula oxygen: O2 (2 litres min−1) was administered via a nasal cannula]; the supplementary oxygen via WNJ group [WNJ oxygen: O2 (2 litres min−1) was administered through a WNJ]; and the SJOV via WNJ group (WNJ SJOV: SJOV was administered via WNJ) at three centres from March 2015 to July 2016. The primary outcome of interest was the incidence of hypoxia (peripheral oxygen saturation of 75–89%). Other adverse events were also recorded.
Supraglottic jet oxygenation and ventilation decreased the incidence of hypoxia from 9 to 3% (P<0.0001). No severe hypoxia occurred in the WNJ SJOV group, one instance occurred in the WNJ oxygen group, and two instances were observed in the nasal cannula oxygen supply control group. Supraglottic jet oxygenation and ventilation-related minor adverse events increased significantly within 1 min after the procedure but decreased 30 min later.
The use of SJOV during upper gastrointestinal endoscopy for patients who are sedated with propofol reduces the incidence of hypoxia, with minor and tolerable adverse events. Supraglottic jet oxygenation and ventilation has a favourable risk-to-benefit ratio and may improve patient safety.
NCT02436018.