In a trial at Our Lady of Lourdes Hospital, Drogheda, consultant anaesthetist Dr Jubil Thomas, demonstrated the ability of High Flow Oxygen Therapy (HFOT) and Continuous Positive Airway Pressure (CPAP) to adequately oxygenate patients both pre and post operatively, with the potential to improve throughput within the theatres and reduce post operative ICU admissions. 

The use of High Flow Oxygen Therapy (HFOT) is increasing both for Preoxygenation and Apnoeic Ventilation (particularly for ENT cases), but also for difficult airway management and Rapid Sequence Induction (RSI). Several devices exist for the provision of HFOT however, a device which delivers only HFOT has limitations. A device which can also provide CPAP has additional benefits such as the ability to follow the patient throughout the peri-operative setting and the option to escalate therapy. 

Firstly, in pre-op to provide pre-oxygenation for high-risk patients, some studies have reported an association between severe obesity and difficult intubation, male patients with severe obesity, especially ones with BMI more than 50 and obstructive sleep apnoea (OSA), as well as patients with a neck circumference > 42 cm had a higher risk of difficult mask ventilation and intubation [1]. Enhanced Recovery after Surgery (ERAS) suggest the use of high flow should be considered as an adjunct during mask ventilation in patients with a suspected or known difficult intubation. This has been demonstrated to help maintain oxygenation by increasing apnoea time up to 40% and can reduce peri-intubation desaturation during anaesthesia induction [2].

Following on from surgery the patient can transition with ease onto CPAP which is beneficial for bariatric patients as they can develop increased work of breathing as well as higher risk of perioperative atelectasis persisting for longer duration compared to patients with normal [2] weight. These patients can often remain longer in recovery and the potential to deliver CPAP quickly may well shorten their time in recovery thus assisting with the patient throughput in the Operating Room. 

In the UK, one in three people who access the health service have two or more chronic conditions and one in three adults admitted to hospital as an emergency in the UK have five or more comorbidities [3]. Comorbidities are more frequent in the obese population, including those requiring surgical intervention. It is estimated that approximately 30% of the general surgical population present with obesity [4]. 

It is therefore fair to assume that hospitals are operating on more patients classed as clinically obese with increased likelihood of obstructed airways and complications both during surgery and recovery. The World Health Organisation Regional Obesity Report 2022 estimated that 26% of the population in Ireland and 28% in the UK [5] are obese, with a BMI over 30. As patients presenting for surgery become more complex, the use of heated humidified therapies such as HFOT and CPAP during recovery is becoming more common. 

Our Lady of Lourdes Hospital in Drogheda is finding the number of patients undergoing ENT surgeries with significant comorbidities is increasing. They are operating on more patients classed as clinically obese with increased likely hood of obstructed airways and complications both during surgery and recovery.