Successful use of high flow nasal cannula in an obese patient with hypoxemia during endoscopic retrograde cholangiopancreatography: a case report
Valentina Ješić
Abstract
A 42-year-old obese woman with a body mass index of 37.8 kilograms per square meter, diabetes, epilepsy, and heavy smoking developed hypoxemia during endoscopic retrograde cholangiopancreatography despite maximal oxygen delivery through a conventional nasal cannula at 12 liters per minute. During sedation with propofol and sufentanil, peripheral oxygen saturation decreased to 76 percent. Switching to high flow nasal cannula oxygen therapy at a flow of 45 liters per minute and a fraction of inspired oxygen of 0.50 rapidly improved oxygenation to 93 to 95 percent within minutes, allowing the procedure to be completed safely. This case illustrates how high flow nasal cannula oxygen therapy can rapidly reverse severe hypoxemia and enable safe completion of endoscopic retrograde cholangiopancreatography in a high-risk obese patient.
Keywords
References
1. Kang H, Lee B, Jo JH, Lee HS, Park JY, Bang S, et al. Machine-learning model for the prediction of hypoxaemia during endoscopic retrograde cholangiopancreatography under monitored anaesthesia care. Yonsei Med J. 2023;64(1):25-34. https://doi.org/10.3349/ymj.2022.0381. PMid:36579376.
2. Khanna P, Haritha D, Das A, Sarkar S, Roy A. Utility of high-flow nasal oxygen in comparison to conventional oxygen therapy during upper gastrointestinal endoscopic procedures under sedation: a systematic review and meta-analyses. Indian J Gastroenterol. 2023;42(1):53-63. https://doi.org/10.1007/s12664-022-01308-6. PMid:36780095.
3. Hung KC, Ko CC, Chang PC, Wang KF, Teng IC, Lin CH, et al. Efficacy of high-flow nasal oxygenation against peri- and post-procedural hypoxemia in patients with obesity: a meta-analysis of randomized controlled trials. Sci Rep. 2022;12(1):6448. https://doi.org/10.1038/s41598-022-10396-5. PMid:35440712.
4. Lin Y, Zhang X, Li L, Wei M, Zhao B, Wang X, et al. High-flow nasal cannula oxygen therapy and hypoxia during gastroscopy with propofol sedation: a randomized multicenter clinical trial. Gastrointest Endosc. 2019;90(4):591-601. https://doi.org/10.1016/j.gie.2019.06.033. PMid:31278907.
5. Zhang CC, Ganion N, Knebel P, Bopp C, Brenner T, Weigand MA, et al. Sedation-related complications during anesthesiologist-administered sedation for endoscopic retrograde cholangiopancreatography: a prospective study. BMC Anesthesiol. 2020;20(1):131. https://doi.org/10.1186/s12871-020-01048-0. PMid:32466744.
6. Kilic ET, Sayar S, Kahraman R, Ozdil K. The effects of obesity on sedation-related outcomes of advanced endoscopic procedures. North Clin Istanb. 2019;6(4):321-6. PMid:31909375.
7. Chen B, Yo C, Patel R, Liu B, Su KY, Hsu WT, et al. Morbid obesity but not obesity is associated with increased mortality in patients undergoing endoscopic retrograde cholangiopancreatography: a national cohort study. United European Gastroenterol J. 2021;9(5):561-70. https://doi.org/10.1002/ueg2.12070. PMid:33951338.
8. Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016;61(4):529-41. https://doi.org/10.4187/respcare.04577. PMid:27016353.
9. Thiruvenkatarajan V, Sekhar V, Wong DT, Currie J, Van Wijk R, Ludbrook GL. Effect of high-flow nasal oxygen on hypoxaemia during procedural sedation: a systematic review and meta-analysis. Anaesthesia. 2023;78(1):81-92. https://doi.org/10.1111/anae.15845. PMid:36044543.
10. Leeies M, Flynn E, Turgeon AF, Paunovic B, Loewen H, Rabbani R, et al. High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Syst Rev. 2017;6(1):202. https://doi.org/10.1186/s13643-017-0593-5. PMid:29037221.
11. Wang L, Zhang Y, Han D, Wei M, Zhang J, Cheng X, 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. BMJ. 2025;388:e080795. doi:10.1136/bmj-2024-080795.
12. Lee C, Perez O, Farooqi F, Akella T, Shaharyar S, Elizee M. Use of high-flow nasal cannula in obese patients receiving colonoscopy under intravenous propofol sedation: a case series. Respir Med Case Rep. 2018;23:118-21. https://doi.org/10.1016/j.rmcr.2018.01.009. PMid:29719796.
Submitted date:
10/28/2025
Accepted date:
01/16/2026
Facebook
LinkedIn
Mendeley
Reddit
Email