AUTHOR=Liu Jianxia , Xiong Ling , Li Haisu , Du Min , Ru Xue , Xu Ying 

TITLE=Comparison of the application of high-flow nasal oxygen with two different oxygen concentrations in infant and child laryngotracheal surgery

JOURNAL=Frontiers in Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1169345

DOI=10.3389/fmed.2023.1169345

ISSN=2296-858X

ABSTRACT=Background: This study aimed to compare the use of the STRIVE Hi technique with 70% and 100% oxygen concentrations in children with 1st or 2nd degree laryngeal obstruction undergoing suspension laryngoscopic surgery.
Methods: Children aged 1 month to 6 years scheduled for suspension laryngoscopic surgery with spontaneous respiration were randomly divided into the 70% oxygen concentration group (HFNO70% group) and the 100% oxygen concentration group (HFNO100% group). The data recorded for all the patients included age and sex, comorbidities, preoperative physiological status, methods of induction and maintenance of anaesthesia, course of the disease and surgical options, lowest oxygen saturation recorded, transcutaneous CO2, oxygen partial pressure PaO2, carbon dioxide partial pressure PaCO2, duration of operation, and rescue method.
Results: A total of 80 children with 1st or 2nd degree laryngeal obstruction were included in the analysis. The median [IQR (range)] duration of spontaneous ventilation using STRIVE Hi was 52.5 [40–60 (30–170)]min and 62.5 [45–81 (20–200)]min in the HFNO 70% and HFNO 100% groups, respectively(P=0.99); the lowest oxygen saturation recorded during the operation was 97.8 ± 2.1% and 96.8 ± 2.5%, respectively(P=0.053); the mean PaO2 at the end of surgery was 184.6±56.3 mmHg and 315.2±101.3 mmHg, respectively(P<0.001); and the peak transcutaneous CO2 was 58.0 ± 13.0 mmHg and 60.4 ± 10.9 mmHg, respectively(P=0.373), despite a long operation time.
Conclusions: STRIVE Hi had a positive effect on children undergoing tubeless laryngeal surgery with spontaneous ventilation,  and for children with 1st or 2nd degree laryngeal obstruction, there was no significant difference in maintaining the intraoperative oxygenation between the 70% and 100% oxygen concentration groups. The 100% oxygen concentration group showed significant hyperoxia, which has been proven to be associated with multiple organ damage. Using a relatively lower oxygen concentration of 70% can effectively reduce the hazards associated with hyperoxia compared to 100% oxygen concentration.