Effect of high-flow nasal cannula oxygen therapy on hypoxemia in obese patients undergoing non-intubated general anesthesia: a meta-analysis and trial sequential analysis_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

YANG Tong , PENG Xueqiang , ZHU Xiaobing , XIAO Zhiheng ,  GAO Duan

Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine(Zhongshan Hospital of Traditional Chinese Medicine), Zhongshan, Guangdong 528400, China;

Corresponding?author：

GAO Duan, Email: 913117984@qq.com

Keywords：

High-flow nasal cannula oxygen therapy; non-intubated general anesthesia; obesity; hypoxemia; randomized controlled trial; meta-analysis; trial sequential analysis

DOI：

10.7507/1671-6205.202605005

Video：

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Objective To systematically evaluate the efficacy of high-flow nasal cannula oxygen therapy (HFNC) versus standard nasal cannula oxygen therapy (SNC) in improving hypoxemia during non-intubated general anesthesia (NIGA) in obese patients. Methods PubMed, Embase, Web of Science, The Cochrane Library, Wanfang Data, CNKI, VIP, and CBM were searched from database inception to March 2026. Two researchers screened the the literature, extracted data, and evaluated the risk of bias in the included studies independently. RevMan 5.4, Stata 15.1 and TSA 0.9.5.10 beta software were used for the meta-analysis and trial sequential analysis. Results A total of 13 RCTs were included, including 1 971 patients. The meta-analysis results showed that compared with the SNC group, the HFNC group reduced the incidence of hypoxemia (RR=0.19, 95%CI 0.07~0.48, P=0.000 4) and mask usage rate (Peto-OR=0.11, 95%CI 0.07~0.17, P<0.000 01), shortened the diagnosis and treatment operation time (MD=?1.78, 95%CI ?2.90~?0.65, P=0.002), but there was no statistically significant difference in the incidence of nasopharyngeal adverse reactions between the two groups (RR=0.55, 95%CI 0.19~1.62, P=0.28). Subgroup analysis showed that there was no statistically significant difference in the incidence of hypoxemia between the HFNC group (under non-pure oxygen conditions) and the SNC group (RR=0.89, 95%CI 0.53~1.50, P=0.67). Conclusions HFNC can reduce the occurrence of hypoxemia and mask intervention during NIGA in obese patients, however, its effect may differ according to the FiO₂ setting. Due to the limitations of the included research quality, more high-quality studies are needed to verify the above conclusions.

Citation： YANG Tong, PENG Xueqiang, ZHU Xiaobing, XIAO Zhiheng, GAO Duan. Effect of high-flow nasal cannula oxygen therapy on hypoxemia in obese patients undergoing non-intubated general anesthesia: a meta-analysis and trial sequential analysis. Chinese Journal of Respiratory and Critical Care Medicine, 2026, 25(8): 545-554. doi: 10.7507/1671-6205.202605005 Copy

1.	中華人民共和國國家衛生健康委員會醫政司. 肥胖癥診療指南(2024版)[J]. 中華消化外科雜志, 2024, 23(10): 1237-1260.
2.	Sundararaman L, Goudra B. Sedation for GI Endoscopy in the Morbidly Obese: Challenges and Possible Solutions[J]. J Clin Med, 2024, 13(16): 4635.
3.	Kaye AD, Lingle BD, Brothers JC, et al. The patient with obesity and super-super obesity: Perioperative anesthetic considerations[J]. Saudi J Anaesth, 2022, 16(3): 332-338.
4.	中華醫學會麻醉學分會氣道學組. 經鼻高流量氧療臨床麻醉規范應用專家共識(2023版)[J]. 臨床麻醉學雜志, 2023, 39(8): 881-887.
5.	Li R, Liu L, Wei K, et al. Effect of noninvasive respiratory support after extubation on postoperative pulmonary complications in obese patients: A systematic review and network meta-analysis[J]. J Clin Anesth, 2023, 91: 111280.
6.	Zhou R, Wang HT, Gu W. Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis[J]. Can Respir J, 2022, 2022: 4415313.
7.	Wang L, Zhang Y, Han D, et al. Effect of high flow nasal cannula oxygenation on incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity: multicentre randomised controlled trial[J]. BMJ, 2025, 388: e080795.
8.	王亮, 劉曉宇, 沈文瑞, 等. 不同模式經鼻高流量吸氧預防肥胖患者非氣管插管全麻期間低氧血癥的效果[J]. 中華麻醉學雜志, 2023, 43(12): 1490-1494.
9.	曾彥茹, 鄭彬, 佘守章, 等. 濕化高流量鼻導管通氣在老年肥胖患者行無痛胃鏡檢查中的應用[J]. 廣東醫學, 2021, 42(9): 1034-1038.
10.	Douglas N, Segal R, O'Donnell K, et al. A randomised controlled trial of high-flow nasal oxygen compared with standard oxygen delivery in obese patients undergoing gastroscopy[J]. Anaesth Intensive Care, 2025 : 310057X251382261.
11.	劉云霞, 彭輝輝, 丁立峰. 快充式經鼻濕化高流量通氣與鼻導管純吸氧對肥胖無痛胃鏡受檢者血流動力學指標及不良事件發生率的影響[J]. 四川生理科學雜志, 2024, 46(5): 1022-1024,1070.
12.	郭豐, 鄒穎華, 王蘭, 等. 濕化高流量鼻導管通氣在肥胖患者中度鎮靜下無痛胃鏡檢查的應用[J]. 浙江臨床醫學, 2023, 25(6): 897-899.
13.	胡兵, 宋偉, 田友芳, 等. 快充式經鼻濕化高流量通氣在肥胖患者行無痛胃鏡檢查中的應用效果[J]. 中國當代醫藥, 2022, 29(23): 122-125.
14.	程曉輝, 趙峰, 王嫻, 等. 快充式經鼻濕化高流量通氣在肥胖患者無痛胃鏡檢查中的應用效果[J]. 中國內鏡雜志, 2022, 28(3): 16-22.
15.	楊天爽, 王倩, 彭蕊, 等. 經鼻濕化高流量通氣在肥胖患者無痛胃鏡檢查中的應用效果[J]. 臨床麻醉學雜志, 2022, 38(9): 949-953.
16.	鄭君剛, 楊余, 李勇, 等. 經鼻高流量氧療在肥胖患者無痛人工流產術中的應用效果[J]. 現代實用醫學, 2022, 34(9): 1198-1200.
17.	鄭少華, 李欣, 每曉鵬, 等. 經鼻高流量氧療應用于肥胖患者無痛結腸鏡的安全性研究[J]. 國際麻醉學與復蘇雜志, 2020, 41(11): 1052-1056.
18.	徐亞杰, 尹加林, 張勇, 等. 快充式經鼻濕化高流量通氣用于肥胖患者無痛胃鏡檢查術的效果[J]. 中華麻醉學雜志, 2020, 40(9): 1125-1128.
19.	Riccio CA, Sarmiento S, Minhajuddin A, et al. High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: A prospective, randomized clinical trial[J]. J Clin Anesth, 2019, 54: 19-24.
20.	Liu H, Qu P, Liu Q, et al. High-flow nasal cannula oxygen therapy: physiological basis and clinical applications in anesthesia[J]. Front Med (Lausanne), 2025, 12: 1661569.
21.	Zhang YX, He XX, Chen YP, et al. The effectiveness of high-flow nasal cannula during sedated digestive endoscopy: a systematic review and meta-analysis[J]. Eur J Med Res, 2022, 27(1): 30.
22.	Gu WJ, Wang HT, Huang J, et al. High flow nasal oxygen versus conventional oxygen therapy in gastrointestinal endoscopy with conscious sedation: Systematic review and meta-analysis with trial sequential analysis[J]. Dig Endosc, 2022, 34(6): 1136-1146.
23.	劉熠, 張毅, 唐永忠, 等. 麻醉恢復室低氧血癥預測模型的建立與校驗[J]. 臨床麻醉學雜志, 2021, 37(1): 55-58.
24.	Carron M, Tamburini E, Safaee Fakhr B, et al. High-flow nasal oxygenation during gastrointestinal endoscopy. Systematic review and meta-analysis[J]. BJA Open, 2022, 4: 100098.
25.	Lin Y, Zhang X, Li L, et al. High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial[J]. Gastrointest Endosc, 2019, 90(4): 591-601.
26.	Zhang W, Yuan X, Shen Y, et al. Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study[J]. Ther Adv Respir Dis, 2024, 18: 17534666241246637.
27.	Song JL, Sun Y, Shi YB, et al. Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis[J]. BMC Anesthesiol, 2022, 22(1): 100.

1. 中華人民共和國國家衛生健康委員會醫政司. 肥胖癥診療指南(2024版)[J]. 中華消化外科雜志, 2024, 23(10): 1237-1260.
2. Sundararaman L, Goudra B. Sedation for GI Endoscopy in the Morbidly Obese: Challenges and Possible Solutions[J]. J Clin Med, 2024, 13(16): 4635.
3. Kaye AD, Lingle BD, Brothers JC, et al. The patient with obesity and super-super obesity: Perioperative anesthetic considerations[J]. Saudi J Anaesth, 2022, 16(3): 332-338.
4. 中華醫學會麻醉學分會氣道學組. 經鼻高流量氧療臨床麻醉規范應用專家共識(2023版)[J]. 臨床麻醉學雜志, 2023, 39(8): 881-887.
5. Li R, Liu L, Wei K, et al. Effect of noninvasive respiratory support after extubation on postoperative pulmonary complications in obese patients: A systematic review and network meta-analysis[J]. J Clin Anesth, 2023, 91: 111280.
6. Zhou R, Wang HT, Gu W. Efficacy of High-Flow Nasal Cannula versus Conventional Oxygen Therapy in Obese Patients during the Perioperative Period: A Systematic Review and Meta-Analysis[J]. Can Respir J, 2022, 2022: 4415313.
7. Wang L, Zhang Y, Han D, et al. Effect of high flow nasal cannula oxygenation on incidence of hypoxia during sedated gastrointestinal endoscopy in patients with obesity: multicentre randomised controlled trial[J]. BMJ, 2025, 388: e080795.
8. 王亮, 劉曉宇, 沈文瑞, 等. 不同模式經鼻高流量吸氧預防肥胖患者非氣管插管全麻期間低氧血癥的效果[J]. 中華麻醉學雜志, 2023, 43(12): 1490-1494.
9. 曾彥茹, 鄭彬, 佘守章, 等. 濕化高流量鼻導管通氣在老年肥胖患者行無痛胃鏡檢查中的應用[J]. 廣東醫學, 2021, 42(9): 1034-1038.
10. Douglas N, Segal R, O'Donnell K, et al. A randomised controlled trial of high-flow nasal oxygen compared with standard oxygen delivery in obese patients undergoing gastroscopy[J]. Anaesth Intensive Care, 2025 : 310057X251382261.
11. 劉云霞, 彭輝輝, 丁立峰. 快充式經鼻濕化高流量通氣與鼻導管純吸氧對肥胖無痛胃鏡受檢者血流動力學指標及不良事件發生率的影響[J]. 四川生理科學雜志, 2024, 46(5): 1022-1024,1070.
12. 郭豐, 鄒穎華, 王蘭, 等. 濕化高流量鼻導管通氣在肥胖患者中度鎮靜下無痛胃鏡檢查的應用[J]. 浙江臨床醫學, 2023, 25(6): 897-899.
13. 胡兵, 宋偉, 田友芳, 等. 快充式經鼻濕化高流量通氣在肥胖患者行無痛胃鏡檢查中的應用效果[J]. 中國當代醫藥, 2022, 29(23): 122-125.
14. 程曉輝, 趙峰, 王嫻, 等. 快充式經鼻濕化高流量通氣在肥胖患者無痛胃鏡檢查中的應用效果[J]. 中國內鏡雜志, 2022, 28(3): 16-22.
15. 楊天爽, 王倩, 彭蕊, 等. 經鼻濕化高流量通氣在肥胖患者無痛胃鏡檢查中的應用效果[J]. 臨床麻醉學雜志, 2022, 38(9): 949-953.
16. 鄭君剛, 楊余, 李勇, 等. 經鼻高流量氧療在肥胖患者無痛人工流產術中的應用效果[J]. 現代實用醫學, 2022, 34(9): 1198-1200.
17. 鄭少華, 李欣, 每曉鵬, 等. 經鼻高流量氧療應用于肥胖患者無痛結腸鏡的安全性研究[J]. 國際麻醉學與復蘇雜志, 2020, 41(11): 1052-1056.
18. 徐亞杰, 尹加林, 張勇, 等. 快充式經鼻濕化高流量通氣用于肥胖患者無痛胃鏡檢查術的效果[J]. 中華麻醉學雜志, 2020, 40(9): 1125-1128.
19. Riccio CA, Sarmiento S, Minhajuddin A, et al. High-flow versus standard nasal cannula in morbidly obese patients during colonoscopy: A prospective, randomized clinical trial[J]. J Clin Anesth, 2019, 54: 19-24.
20. Liu H, Qu P, Liu Q, et al. High-flow nasal cannula oxygen therapy: physiological basis and clinical applications in anesthesia[J]. Front Med (Lausanne), 2025, 12: 1661569.
21. Zhang YX, He XX, Chen YP, et al. The effectiveness of high-flow nasal cannula during sedated digestive endoscopy: a systematic review and meta-analysis[J]. Eur J Med Res, 2022, 27(1): 30.
22. Gu WJ, Wang HT, Huang J, et al. High flow nasal oxygen versus conventional oxygen therapy in gastrointestinal endoscopy with conscious sedation: Systematic review and meta-analysis with trial sequential analysis[J]. Dig Endosc, 2022, 34(6): 1136-1146.
23. 劉熠, 張毅, 唐永忠, 等. 麻醉恢復室低氧血癥預測模型的建立與校驗[J]. 臨床麻醉學雜志, 2021, 37(1): 55-58.
24. Carron M, Tamburini E, Safaee Fakhr B, et al. High-flow nasal oxygenation during gastrointestinal endoscopy. Systematic review and meta-analysis[J]. BJA Open, 2022, 4: 100098.
25. Lin Y, Zhang X, Li L, et al. High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial[J]. Gastrointest Endosc, 2019, 90(4): 591-601.
26. Zhang W, Yuan X, Shen Y, et al. Optimal flow of high-flow nasal cannula oxygenation to prevent desaturation during sedation for bronchoscopy: a randomized controlled study[J]. Ther Adv Respir Dis, 2024, 18: 17534666241246637.
27. Song JL, Sun Y, Shi YB, et al. Comparison of the effectiveness of high-flow nasal oxygen vs. standard facemask oxygenation for pre- and apneic oxygenation during anesthesia induction: a systematic review and meta-analysis[J]. BMC Anesthesiol, 2022, 22(1): 100.

Chinese Journal of Respiratory and Critical Care Medicine

Effect of high-flow nasal cannula oxygen therapy on hypoxemia in obese patients undergoing non-intubated general anesthesia: a meta-analysis and trial sequential analysis

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