A comparison of gastric gas volumes measured by computed tomography after high‐flow nasal oxygen therapy or conventional facemask ventilation*

Abstract

High‐flow nasal oxygen therapy is increasingly used to improve peri‐intubation oxygenation. However, it is unknown whether it may cause or exacerbate insufflation of gas into the stomach. High‐flow nasal oxygen therapy is now standard practice in our hospital for adult patients undergoing percutaneous thermal ablation of liver cancer under general anaesthesia with tracheal intubation. We compared gastric gas volumes measured from computed tomography images that had been acquired immediately after intubation in two series of patients: 50 received peri‐intubation high‐flow nasal oxygen therapy and another 50 received conventional facemask pre‐oxygenation and ventilation before intubation and before high‐flow nasal oxygen therapy became standard practice in our unit. Median (IQR [range]) gastric gas volume was 24.0 (14.2–59.9 [3–167]) cm³ in the high‐flow nasal oxygen therapy group and 23.8 (12.6–38.8 [0–185]) cm³ in the facemask group. There was no difference between the two groups in the volume of gastric gas measured by computed tomography imaging (Mann–Whitney U‐test, U = 1136, p = 0.432, n₁ = n₂ = 50). Our results demonstrate that a small volume of gastric gas is commonly present after induction of anaesthesia, but that the use of peri‐intubation high‐flow nasal oxygen therapy for pre‐oxygenation and during apnoea does not increase this volume compared with conventional facemask pre‐oxygenation and ventilation. This is clinically relevant, as high‐flow nasal oxygen therapy is increasingly being used in a peri‐intubation context and in patients at higher risk of aspiration.