High Flow Oxygen Therapy in the Perioperative Period
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High Flow Oxygen Therapy in the Perioperative Period
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What does high flow oxygen therapy consist of?
HFOT involves the administration of warm, humidified oxygen through nasal cannulas at high flow rates (20-70 L/min). This system is capable of delivering a precise, consistent FiO₂, adjustable from 21% to 100% oxygen. HFNC creates low levels of positive airway pressure, decreases pharyngeal dead space and work of breathing and improves comfort and oxygenation compared to conventional low flow systems. Unlike conventional oxygen therapy, HFNC improves safety in the anaesthesic setting by reducing the risk of hypoxaemia.
Perioperative uses
HFNC therapy has progressively been introduced at different points during the perioperative period: just before induction of anaesthesia, during procedures under different levels of sedation and in the postoperative period.
Before anaesthesia
HFNC therapy is used at this stage for preoxygenation and apnoeic oxygenation in the induction of anaesthesia and when intubation is difficult. It prolongs safe apnoea time during induction (in manoeuvres such as laryngoscopy or the insertion of a laryngeal mask airway) and maintains better oxygenation in adults and children, especially in those with difficult airway or who are at risk of desaturation. For adults, HFNC is superior to an oxygen mask for preoxygenation and apnoeic oxygenation during rapid sequence induction and it helps keep the upper airway patent.
During anaesthesia
The use of HFNC during procedures performed outside the operating theatre under deep sedation has expanded over recent years. This is particularly interesting in gastrointestinal endoscopy, bronchoscopy and cardiological or endovascular procedures for patients with a moderate-high risk of desaturation. It is also indicated for patients at risk of hypoxaemia, respiratory depression and the need for airway management, without increasing the risk of adverse events.
A recent study found that HFNC therapy is not inferior to a laryngeal mask airway for short-term anaesthesia procedures that do not require neuromuscular blocking. However, close monitoring is required in these cases due to the risk of hypercapnia.
HFNC therapy can be used as respiratory support in thoracic surgery and non-intubated airway procedures. In some cases, it can be used during surgery for maintaining oxygenation, provided that it is monitored by trained anaesthesiologists.
After anaesthesia
Under these conditions, measures focus on preventing postanaesthetic respiratory failure. HFNC may avoid the need for escalation of respiratory support and reduce the duration of hospital stays, particularly in patients with a high risk of pulmonary complications.
Clinical evidence and benefits
- Improved arterial oxygenation.
- Decreased work of breathing.
- Reduced need for invasive ventilation.
- Improved tolerance in critically ill patients.
Practical aspects
Conclusion
HFOT is a new tool used in perioperative care. Its adaptability, effectiveness and safety make it a useful option for improving patient respiratory prognosis and increasing their safety in the anaesthetic setting, provided it is used with precise indication and expert monitoring. When used appropriately, HFNC can reduce respiratory complications, improve patient experience and optimise resources in the perioperative setting.
Dr Mercedes López Martínez
Anaesthesiologist, La Paz University Hospital
References
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