High-flow nasal oxygen (HFNO) therapy is widely used in critical care obstetrics to improve oxygenation. Much of the benefit of HFNO is linked to the creation of modest levels of positive airway pressure. Pregnant women are generally considered to be at high risk of regurgitation and aspiration. It is unknown whether HFNO may cause gas insufflation into the stomach and further increase this risk. Therefore, this study aimed to systematically evaluate the possible safety effects of HFNO on gastric volume in healthy fasted parturients.
Sixty fasted parturients scheduled for elective cesarean delivery were enrolled in an observer-blinded, prospective, interventional study. We used ultrasonography to assess changes of antral cross-sectional area (CSA) and gastric volume before and after a 20-minute treatment with HFNO at a rate of 50 L·min–1. The primary outcome was the change in gastric volume from before to after HFNO therapy, and the secondary outcome was the distribution of antral grades.
In semirecumbent right lateral position, the antral CSA at baseline and after treatment with HFNO was 3.81 (3.01–4.72) cm2 and 3.79 (3.03–4.54) cm2, respectively. The estimated fluid volume at baseline and after treatment with HFNO was 38.51 (33.39–54.62) mL and 39.71 (32.00–52.82) mL, respectively. All participants had either a grade 0 or grade 1 antrum, and most of them had a grade 0 antrum. There was no significant difference in gastric volume and distribution of antral grades before and after HFNO therapy. Gastric air distension was not shown in any of the parturients either at baseline or after treatment with HFNO.
Treatment with HFNO for 20 minutes at flow rates up to 50 L·min–1 did not increase gastric volume in term pregnant women breathing spontaneously when evaluated by gastric ultrasonography.