Efficacy of nasal clips combined with nasal cannulas in preventing hypoxemia during gastrointestinal endoscopy with sedation: a randomized controlled trial.

Abstract

Background: Gastrointestinal endoscopy with sedation is frequently complicated by hypoxemia. Nasal cannulas have limitations in eliminating hypoxemia. We hypothesized that the combination of nasal clips and nasal cannulas would improve the inspired oxygen concentrations and prevent hypoxemia compared with the use of nasal cannulas alone.

Methods: A total of 600 adult patients were randomly assigned to receive supplemental oxygen through single-lumen nasal cannulas or through the combination of nasal clips and nasal cannulas. The primary outcome was the incidence of hypoxemia. Additionally, subclinical respiratory depression and severe hypoxemia, duration of hypoxemia, lowest SpO₂ level, measures to increase oxygen saturation level, and adverse events such as cough and hiccups were compared as secondary outcomes.

Results: Three hundred patients in the nasal clip group and 296 patients in the nasal cannula group were included in the intention-to-treat analysis. Nasal clips significantly decreased the incidence of hypoxemia from 25.0-17.7%(RR = 0.707, 95% CI = 0.516 to 0.967, P = 0.029). The median and interquartile range of lowest SpO₂ in the nasal clip group (96 [92 to 98]) was significantly greater than that in the nasal cannula group (95 [89 to 97]; median difference = 1.000, 95% CI = 0.000 to 2.000, P = 0.004). No significant differences were found between the two groups in subclinical respiratory depression or severe hypoxemia, duration of hypoxemia, adverse events or measures taken to increase oxygen saturation.

Conclusions: The combination of nasal clips and cannulas reduces hypoxemia during gastrointestinal endoscopy with sedation, demonstrating a significant advantage over the sole use of nasal cannulas, with tolerable adverse events.

Trial registration: Chinese Clinical Trial Registry (ChiCTR2200065407).