{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T06:46:50Z","timestamp":1792824410920,"version":"4.5.0"},"reference-count":33,"publisher":"BMJ","license":[{"start":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T00:00:00Z","timestamp":1739232000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2025,1,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether high flow nasal cannula (HFNC) oxygenation can reduce the incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre, randomised, parallel group trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Three tertiary hospitals in Shanghai, China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>1000 adult patients with obesity (body mass index \u226528) who were scheduled for gastrointestinal endoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants were randomly allocated to receive regular nasal cannula oxygenation or HFNC oxygenation during a sedated procedure with propofol and low dose sufentanil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>\n                      The primary outcome was the incidence of hypoxia (75%\u2264SpO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;90% for &lt;60 s) during the procedure. Secondary outcomes included the incidences of subclinical respiratory depression (90%\u2264SpO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;95% for any duration) and severe hypoxia (SpO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;75% for any duration or 75%\u2264SPO\n                      <jats:sub>2<\/jats:sub>\n                      &lt;90% for &gt;60 s) during the procedure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 6 May 2021 to 26 May 2023, 984 patients (mean age 49.2 years; 36.9% (n=363) female) completed the study and were analysed. Compared with regular nasal cannula oxygenation, HFNC oxygenation reduced the incidence of hypoxia from 21.2% (103\/487) to 2.0% (10\/497) (difference \u221219.14, 95% confidence interval \u221223.09 to \u221215.36; P&lt;0.001), subclinical respiratory depression from 36.3% (177\/487) to 5.6% (28\/497) (difference \u221230.71, \u221235.40 to \u221225.92; P&lt;0.001), and severe hypoxia from 4.1% (20\/487) to 0% (0\/497) (difference \u22124.11%, \u22126.26 to \u22122.48; P&lt;0.001). Other sedation related adverse events did not differ between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with obesity, oxygenation via HFNC during sedated gastrointestinal endoscopy significantly reduced the incidences of hypoxia, subclinical respiratory depression, and severe hypoxia without increasing other adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      ClinicalTrials.gov\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT04500392\" ext-link-type=\"clintrialgov\">NCT04500392<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  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