Hypoxemia is the most common adverse event during propofol sedation for gastrointestinal endoscopy in patients with chronic obstructive pulmonary disease (COPD) due to diminished pulmonary reserve. Although high-flow nasal cannula (HFNC) oxygenation has been shown to effectively reduce hypoxemia during sedated endoscopy in obese patients, its application in COPD patients remains an evidence gap, largely owing to the traditional concern that high-concentration oxygen may suppress respiratory drive and exacerbate CO₂ retention. This study aims to investigate whether HFNC can reduce the incidence of hypoxemia during sedated gastrointestinal endoscopy in patients with COPD.
Age ≥18 years;
Confirmed diagnosis of chronic obstructive pulmonary disease (COPD);
Scheduled for elective sedated gastroenteroscopy (gastroscopy, colonoscopy, or combined gastroscopy and colonoscopy);
Expected procedure duration ≤45 minutes;
Patients with absolute contraindications to high-flow therapy, including but not limited to confirmed diagnosis of complete upper airway obstruction, basilar skull fracture or nasal bone fracture, pneumothorax, or pneumomediastinum.;
American Society of Anesthesiologists (ASA) Physical Status class ≥ IV;
Requirement for planned endotracheal intubation;
Existing tracheostomy;
Single group
High-flow nasal cannula
DeviceUsing high-flow nasal cannula oxygenation
The incidence of hypoxemia
75% ≤ SpO2 \< 90% for \<60 s
The incidence of sub-clinical respiratory depression
90% ≤ SpO2 \< 95%
The incidence of severe hypoxemia
SpO2 \< 75% or 75% ≤ SpO2 \< 90% for ≥60 s
The incidence of other adverse events
Other adverse events recorded by tools proposed by the World Society of Intravenous Anesthesia International Sedation Task Force
QoR-PACU₂-15 score at PACU discharge
QoR-PACU₂-15 assessed at PACU discharge to evaluate early recovery quality (15 items, each scored 0-5; total score 0-75, higher scores indicate better recovery).
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