Evidence map›Paper›PMID 40598378›Full record

Trial reportBMC research notes2025

Randomized controlled trial to assess the effectiveness of apnoeic oxygenation in adults using a low-flow or high-flow nasal cannula with head side elevation during endotracheal intubation in the emergency department.

Shahan Waheed, Nazir Najeeb Kapadia, Dr Rida Jawed, Ahmed Raheem, Muhammad Faisal Khan

Erratum issued Registry-linked trialAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC research notes, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT04242537 (A Randomized Control Trial to Assess the Effectiveness of Apneic Oxygenation in Adults Using Low Flow or High Flow Nasal Cannula With Head Side Elevation Compared With Usual Care to Prevent Desaturation During Endotracheal Intubation), which is not on this map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04242537 naunknown statusnot on this map

A Randomized Control Trial to Assess the Effectiveness of Apneic Oxygenation in Adults Using Low Flow or High Flow Nasal Cannula With Head Side Elevation Compared With Usual Care to Prevent Desaturation During Endotracheal Intubation

TypeinterventionalSponsorAga Khan University Hospital, PakistanRan2020 to 2021Enrolled30ConditionsApneic OxygenationArmsHigh flow nasal cannula oxygen delivery, Low flow nasal cannula oxygen delivery
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Shahan WaheedDepartment of Emergency Medicine, Aga Khan University and Hospital (AKUH), Karachi, Pakistan.
Nazir Najeeb KapadiaDepartment of Emergency Medicine, King Hamad University Hospital, Al Muharraq, Bahrain.
Dr Rida JawedDepartment of Emergency Medicine, Aga Khan University and Hospital (AKUH), Karachi, Pakistan. rida.jawed@aku.edu.
Ahmed RaheemDepartment of Emergency Medicine, Aga Khan University and Hospital (AKUH), Karachi, Pakistan.
Muhammad Faisal KhanDepartment of Anesthesiology, Aga Khan University and Hospital (AKUH), Karachi, Pakistan.

Funding

University Research Council, Aga Khan University Grant 192002ER-PK
6 · The paper itself

Abstract

objectiveAlthough apnoeic oxygenation has demonstrated efficacy in extending safe apnea time during intubation, a superiority comparison between high-flow nasal cannula (HFNC) and low-flow nasal cannula (LFNC) in emergency settings remains unexplored. This randomized controlled trial evaluated whether apnoeic oxygenation using HFNC or LFNC with head elevation improves oxygenation and intubation outcomes compared to standard care without oxygen delivery.

methodsWe conducted a three-arm randomized trial using block randomization (1:1:1) at a tertiary care emergency department. Adult patients requiring intubation were randomized to receive apnoeic oxygenation via HFNC (20 L/min), LFNC (10 L/min), or standard care. The primary outcome was the lowest oxygen saturation 3 min post-intubation, and co-primary outcome was first-pass success rate. Secondary outcomes were safe apnea time, post-intubation complications (hypotension, desaturation, arrhythmia), laryngoscopic view, and the need for adjuncts. Intention-to-treat analysis was applied.

resultsOur study investigated endotracheal intubation in 88 patients, divided into high flow, low flow, and standard care groups. The high flow group had the highest median SpO2 and less variability than other groups. The standard group had the highest first attempt success rate (93%). The high flow group had a statistically significant shorter Apnea duration than the low flow group. The low flow group had a higher prevalence of hypotension (46%) and oxygen desaturation (57%) post-intubation.

conclusionHFNC with head-elevated positioning reduces post-intubation desaturation and hypotension compared to LFNC and standard care. HFNC may be a beneficial adjunct during emergency intubation, particularly in patients at risk of hypoxia or hemodynamic instability. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry: NCT04242537 on 2020-01-27.

Indexed as

ApneaCannulaEmergency Service, HospitalIntubation, IntratrachealOxygen Inhalation TherapyAdultAgedFemaleHeadHumansMaleMiddle AgedOxygen SaturationTreatment OutcomeApneaHypoxiaIntubationOxygen saturation

Identifiers

PMID40598378
PMCPMC12219693

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.