Pulmonary Atelectasis, Patient Comfort
Conditions
Keywords
Awake Craniotomy, HFNC, Oxygen Therapy, Atelectasis, Ultrasound, Patient Comfort
Brief summary
Background: Patients undergoing awake brain surgery are exposed to non-humidified, non-warmed oxygen/air mix flow through a face mask for a prolonged duration. This causes increased discomfort, inadequate breathing with the risk for hypoxia perioperatively. Humidified high flow nasal cannula (HFNC) oxygen therapy potentially improves patient comfort, oxygen/air exchange, improves surgical conditions and prevents atelectasis of the lung, compared to traditional oxygen administration using a face mask in patients undergoing awake brain surgery. Results of this trial will be used to initiate a more extensive, multicenter trial to further characterize the potential impact of HFNC.
Detailed description
Background: Patients undergoing awake brain surgery are exposed to non-humidified, non-warmed oxygen/air mix flow through a face mask for a prolonged duration. This causes increased discomfort, inadequate breathing with the risk for hypoxia perioperatively. Hypothesis: Humidified high flow nasal cannula (HFNC) oxygen therapy improves patient comfort, oxygen/air exchange, improves surgical conditions and prevents atelectasis of the lung, compared to traditional oxygen administration using a face mask in patients undergoing awake brain surgery. Methods: After obtaining ethics approval and written informed patient consent, 20 patients undergoing scheduled awake brain surgery will be randomized to either HFNC therapy or standard face mask. Evaluation of patient satisfaction, pain / dry upper airway along with drawing of arterial blood gases to measure oxygen/carbon dioxide content of the blood will be performed during and after the procedure. Lung ultrasound will be performed in the recovery room to determine the presence of atelectasis. Expected results and Significance: We expect that HFNC improves patient comfort as well as breathing / arterial oxygen content in long-duration awake brain surgery. This could result in higher patient satisfaction, shorter times in PACU, a shorter requirement for oxygen therapy, decreased risk for hypoxia during surgery and better elimination of carbon dioxide - which could lead to better surgical conditions due to softer brain tissue and therefore shorter time for the surgical procedure. Potential positive results of this trial will be used to initiate a more extensive, multicenter trial to further characterize the potential impact of HFNC.
Interventions
DEVICEHFNC
High flow nasal humidified oxygen HFNC is an air-oxygen blender, which provides high flow (up to 60 L/min) of warmed (36°C) and humidified gas through nasal cannula, allowing tighter control of FiO2 from 0.2 to 1.0.
DEVICEOxygen Mask
Application of oxygen during conscious sedation
Sponsors
Western University, Canada
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* adult patients undergoing elective awake craniotomy
Exclusion criteria
* ASA \> 4 * pregnant females * Body Mass Index (BMI) \> 40 * elective postoperative mechanical ventilation/conversion to general anesthesia * denial of consent * obstructive sleep apnea requiring CPAP * severe COPD requiring home oxygen therapy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Patient comfort using VAS (1-10) | During surgical procedure, an average of 6 hours | Patient comfort during awake craniotomy |
Secondary
| Measure | Time frame |
|---|---|
| Gas exchange (blood gas analysis) | During surgical procedure (an average of 6 hours) and 15 minutes after PACU admission |
| Post-operative pulmonary atelectasis using Ultrasound evaluation | Up to 15 minutes before PACU discharge |
| Incidence of oxygen desaturation (number of events with SaO2 < 90%) | During surgical procedure, an average of 6 hours |
Countries
Canada
Outcome results
None listed