High flow nasal oxygenation in sedated gastrointestinal endoscopy for patients with obesity

Gastrointestinal endoscopy under sedation is a cornerstone for diagnosing and managing digestive diseases.12 It is generally considered safe, with serious adverse events reported in fewer than 1% of cases.34 Sedation enhances comfort and success,1234 with the type and amount being tailored to the complexity of the procedure and patient related factors.12 However, sedation suppresses airway dilator muscle activity and respiratory function, reducing airway patency and ventilation.5 Hypoxaemia, the most common adverse event during sedated gastrointestinal endoscopy,12 has been reported in a wide range of cases,56 occurring in up to 60% depending on its definition.6 Patients with obesity are at increased risk owing to upper airway obstruction and impaired respiratory mechanics,5 exacerbated by endoscope insertion and gas insufflation.125 Consequently, maintaining adequate ventilation and oxygenation is a challenge for clinicians managing high risk populations.1256 Conventional oxygen supplementation, typically using nasal prongs or facemasks, delivers oxygen at a maximum flow of 10-15 L/min with a fraction of inspired oxygen (FiO₂) ranging from 0.3 to 0.6.56 High flow nasal oxygen supplementation delivers an FiO₂ up to 1.0 with flow …