Usage of High Flow Nasal Cannula in Preventing Desaturations in Elderly Patients Going for Lower Limb Surgeries

Study Overview
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Brief Summary
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To study the effect of high flow nasal cannula in comparisons with nasoprong used intraoperatively in patients oxygenation status

Detailed Description
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To observe the effect of high flow nasal cannula used intraoperatively compared to normal oxygen therapy (nasoprong) at a same fraction of inspired oxygen (FiO2) in elderly patients who are going for orthopaedic surgeries under central neuraxial block. oxygenation will be access with intermittent blood gas. atelectasis will be access via chest x-ray , compared to a baseline chest x-ray, validated by a blinded radiologist

Official Title
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Comparing Intraoperative High Flow Nasal Cannula Therapy and Convetional Oxygen Therapy in Preventing Perioperative Hypoxaemia In Elderly Patients Undergoing Orthopaedic Surgery: A Randomized Controlled Study

Conditions
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Hypoxemia During Surgery, Atelectasis

Intervention / Treatment
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* Device: high flow nasal cannula
* Device: nasoprong oxyen 2Litres per minute


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: American Society of Anesthesiologists (ASA) I, II or III patients. Patients age 60 years and above Patients scheduled for total knee replacement therapy and hip surgeries under central neuraxial block under the elective and emergency list. Exclusion Criteria: Patients with pre-operative spO2<94% Patients delirious or demented / unable to give consent. Patients with pre-existing pneumonia (defined as the initiation of antibiotics for suspected infection with one or more of the following: new or changed sputum; new or changed lung opacities; fever; white blood cell count >12 × 109 litre-1 )15 BMI ≥35

Ages Eligible for Study
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Minimum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: patient receiving high flow nasal cannula (A)<br>Patient will be put on high flow nasal cannula at a fixed flow of 50L/min, at Fio2 0.3% throughout surgery. Oxygen therapy will be discontinued once surgery ends. FiO2 will be titrated by 0.1 increment to a SpO2 of ≥94%. | Device: high flow nasal cannula<br>* high flow nasal cannula provides heated and humidified gas to the airways via nasal prongs at a prescribed accurate fraction of inspired oxygen (FiO2) ranging from 0.21 to 1.0 and with a higher flow rate of up to 60 litres per minute<br>|
| Active Comparator: patient receiving nasoprong oxygen 2 L/min<br>Patient will be put nasoprong oxygen 2L/min throughout surgery. Oxygen therapy will be discontinued once surgery ends. FiO2 will be titrated by 0.1 increment to a SpO2 of ≥94%. | Device: nasoprong oxyen 2Litres per minute<br>* nasoprong @L/min will deliver approximately a FiO2 of 0.3. subsequently, if incremental O2 is needed, patient will be provided with ventimask 40% and so forth<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Incident of intraoperative desaturation | desaturation is taken as any spO2 <94% | From induction time until end of surgery | 
| Patient comfort on high flow nasal cannula | Patient rate comfort level using Visual Numerical Scale. The scale of 1 to 5 with 1 being extreme discomfort, 3 neutral and 5 extreme comfort | At end of surgery till discharge to ward (recovery area) | 
| Atelactasis | Incident of postoperative atelectasis by compraring the preoperative and postoperative chest x ray by a radiologist | From end of operation until 24 hours post surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of hospital stay | Duration of hospital admission from the time of patient admitted to the hospital, until discharge from hospital | Time of hospital admission to time of discharge up to 30 days which ever come first | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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high flow nasal cannula, elderly, orthopaedic, hypoxaemia, regional anaesthesia