Supraglottic Jet Oxygenation And Ventilation Enhances Oxygenation During Upper-gastrointestinal Endoscopy In Patients Sedated With Propofol:A Randomized Multicentre Clinical Trial

BACKGROUND :Hypoxia is common during the upper gastrointestinal endoscopies procedure with sedation,which are the most common reason for cardiac arrhythmias and mortality.Hypoventilation is the main reason of hypoxia.The key to preventing hypoxia is to maintain the normal ventilation during procedure.We introduced supraglottic jet oxygenation and ventilation(SJOV)through a new Wei Nasal Jet Tube(WNJ)to prevent the hypoxia during upper gastrointestinal endoscopies procedure under propofol infusion.METHODS :In a prospective,case controlled randomized,patients blinded,multicenter clinical trials,1781 outpatients undergoing routine upper GI endoscopy under propofol infusion by anesthesiologist were randomized into three groups,oxygen supply via nasal cannula group(Nasal Cannula Oxygen,O2(2L/min)was given with a regular nasal cannula),Oxygen supply via WNJ group(WNJ Oxygen,O2(2L/min)was given through WNJ and SJOV via WNJ group(WNJ SJOV,SJOV was performed via WNJ)at Renji Hospital(Shanghai,China),Shanghai Tongji Hospital(Shanghai,China)and Shanghai Pudong New Area People's Hospital(Shanghai,China)from March 2015 to July 2016.The primary outcome is the incidence of subclinical respiratory depression(Sp O2 90%-95%),hypoxia(Sp O2 75%-90%)and severe hypoxia(Sp O2<75% at any time or prolonged(<90% for >60 s)).The adverse events were recorded according to the tools proposed by the world SIVA International Sedation Task Force,which included the different levels of hypoxia.SJOV related adverse events were also recorded.RESULTS :SJOV decreased the incidences of subclinical respiratory depression(from 13.82% to 9.96%,p=0.040)and hypoxia(from 8.93% to 2.53%,p<0.0001)).No severe hypoxia occured in the WNJ SJOV group,while one occurred with WNJ oxygen and 2 in nasal cannula oxygen supply control group.SJOV-related minor adverse events(dry mouth,pharyngalgia and nasal bleeding)were increased significantly within1 minute after procedure,but dramatically decreased 30 minutes later.No barotauma occurred in any patient.CONCLUSIONS :The use of SJOV during upper gastrointestinal endoscopy for patients who are sedated with propofol reduces hypoxia rates with minor and tolerable adverse events.SJOV has a favourable risk/benefit ratio and may improve patient safety.