{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T18:48:35Z","timestamp":1787856515333,"version":"build-2784847793"},"reference-count":50,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T00:00:00Z","timestamp":1703548800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T00:00:00Z","timestamp":1703548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Before tracheal intubation, it is essential to provide sufficient oxygen reserve for emergency patients with full stomachs. Recent studies have demonstrated that high-flow nasal oxygen (HFNO) effectively pre-oxygenates and prolongs apneic oxygenation during tracheal intubation. Despite its effectiveness, the use of HFNO remains controversial due to concerns regarding carbon dioxide clearance. The air leakage and unknown upper airway obstruction during HFNO therapy cause reduced oxygen flow above the vocal cords, possibly weaken the carbon dioxide clearance.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients requiring emergency surgery who had fasted\u2009&lt;\u20098\u00a0h and not drunk\u2009&lt;\u20092\u00a0h were randomly assigned to the high-flow group, who received 100% oxygen at 30\u201360 L\/min through nasopharyngeal airway (NPA), or the mask group, who received 100% oxygen at 8 L\/min. PaO<jats:sub>2<\/jats:sub> and PaCO<jats:sub>2<\/jats:sub> were measured immediately before pre-oxygenation (<jats:italic>T<\/jats:italic>0), anesthesia induction (<jats:italic>T<\/jats:italic>1), tracheal intubation (<jats:italic>T<\/jats:italic>2), and mechanical ventilation (<jats:italic>T<\/jats:italic>3). The gastric antrum\u2019s cross-sectional area (CSA) was measured using ultrasound technology at <jats:italic>T<\/jats:italic>0, <jats:italic>T<\/jats:italic>1, and <jats:italic>T<\/jats:italic>3. Details of complications, including hypoxemia, reflux, nasopharyngeal bleeding, postoperative pulmonary infection, postoperative nausea and vomiting (PONV), and postoperative nasopharyngeal pain, were recorded. The primary outcomes were PaCO<jats:sub>2<\/jats:sub> measured at <jats:italic>T<\/jats:italic>1, <jats:italic>T<\/jats:italic>2, and <jats:italic>T<\/jats:italic>3. The secondary outcomes included PaO<jats:sub>2<\/jats:sub> at <jats:italic>T<\/jats:italic>1, <jats:italic>T<\/jats:italic>2, and <jats:italic>T<\/jats:italic>3, CSA at <jats:italic>T<\/jats:italic>1 and <jats:italic>T<\/jats:italic>3, and complications happened during this trial.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Pre-oxygenation was administered by high-flow oxygen through NPA (<jats:italic>n<\/jats:italic>\u2009=\u200958) or facemask (<jats:italic>n<\/jats:italic>\u2009=\u200957) to 115 patients. The mean (SD) PaCO<jats:sub>2<\/jats:sub> was 32.3 (6.7) mmHg in the high-flow group and 34.6 (5.2) mmHg in the mask group (<jats:italic>P<\/jats:italic>\u2009=\u20090.045) at <jats:italic>T<\/jats:italic>1, 45.0 (5.5) mmHg and 49.4 (4.6) mmHg (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) at <jats:italic>T<\/jats:italic>2, and 47.9 (5.1) mmHg and 52.9 (4.6) mmHg (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) at <jats:italic>T<\/jats:italic>3, respectively. The median ([IQR] [range]) PaO<jats:sub>2<\/jats:sub> in the high-flow and mask groups was 404.5 (329.1\u2013458.1 [159.8\u2013552.9]) mmHg and 358.9 (274.0\u2013413.3 [129.0\u2013539.1]) mmHg (<jats:italic>P<\/jats:italic>\u2009=\u20090.007) at T1, 343.0 (251.6\u2013428.7 [73.9\u2013522.1]) mmHg and 258.3 (162.5\u2013347.5 [56.0\u2013481.0]) mmHg (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) at <jats:italic>T<\/jats:italic>2, and 333.5 (229.9\u2013411.4 [60.5\u2013492.4]) mmHg and 149.8 (87.0\u2013246.6 [51.2\u2013447.5]) mmHg (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.001) at <jats:italic>T<\/jats:italic>3, respectively. The CSA in the high-flow and mask groups was 371.9 (287.4\u2013557.9 [129.0\u2013991.2]) mm<jats:sup>2<\/jats:sup> and 386.8 (292.0\u2013537.3 [88.3\u20131651.7]) mm<jats:sup>2<\/jats:sup> at <jats:italic>T<\/jats:italic>1 (<jats:italic>P<\/jats:italic>\u2009=\u20090.920) and 452.6 (343.7\u2013618.4 [161.6\u2013988.1]) mm<jats:sup>2<\/jats:sup> and 385.6 (306.3\u2013562.0 [105.5\u2013922.9]) mm<jats:sup>2<\/jats:sup> at <jats:italic>T<\/jats:italic>3 (<jats:italic>P<\/jats:italic>\u2009=\u20090.173), respectively. The number (proportion) of complications in the high-flow and mask groups is shown below: hypoxemia: 1 (1.7%) vs. 9 (15.8%, <jats:italic>P<\/jats:italic>\u2009=\u20090.019); reflux: 0 (0%) vs. 0 (0%); nasopharyngeal bleeding: 1 (1.7%) vs. 0 (0%, <jats:italic>P<\/jats:italic>\u2009=\u20091.000); pulmonary infection: 4 (6.9%) vs. 3 (5.3%, <jats:italic>P<\/jats:italic>\u2009=\u20091.000); PONV: 4 (6.9%) vs. 4 (7.0%, <jats:italic>P<\/jats:italic>\u2009=\u20091.000), and nasopharyngeal pain: 0 (0%) vs. 0 (0%).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Compared to facemasks, pre-oxygenation with high-flow oxygen through NPA offers improved carbon dioxide clearance and enhanced oxygenation prior to tracheal intubation in patients undergoing emergency surgery, while the risk of gastric inflation had not been ruled out.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Trial registration<\/jats:title>\n                <jats:p>This trial was registered prospectively at the Chinese Clinical Research Registry on 26\/4\/2022 (Registration number: ChiCTR2200059192).<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-023-02418-2","type":"journal-article","created":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T17:02:22Z","timestamp":1703610142000},"page":"1051-1061","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pre-oxygenation with high-flow oxygen through the nasopharyngeal airway compared to facemask on carbon dioxide clearance in emergency adults: a prospective randomized non-blinded clinical trial"],"prefix":"10.1007","volume":"50","clinical-trial-number":[{"clinical-trial-number":"chictr2200059192","registry":"10.18810\/chictr"}],"author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7969-5365","authenticated-orcid":false,"given":"Jie","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing-he","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua-dong","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-juan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2205-2023","authenticated-orcid":false,"given":"Kang","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,12,26]]},"reference":[{"key":"2418_CR1","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/anae.14500","volume":"74","author":"WJ Fawcett","year":"2019","unstructured":"Fawcett WJ, Thomas M. 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The images or other third party material in this article are included in the article's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit .","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Open access"}}]}}