An interventional study of High-Flow Nasal Cannula and Tight Face Mask in Hypoxemia, Airway Management and Endotracheal Intubation, sponsored by Khyber Teaching Hospital. Not yet recruiting. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-07-23.
Sponsored by Khyber Teaching Hospital · Not applicable, Interventional, and Treatment
This prospective randomized controlled trial aims to compare the effectiveness of High-Flow Nasal Cannula (HFNC) versus Tight Face Mask (TFM) in maintaining oxygenation during rapid sequence induction (RSI) for endotracheal intubation in adult patients. Participants will be randomly assigned in a 1:1 ratio to receive either HFNC or TFM for preoxygenation before induction of anesthesia. The primary outcome is the lowest peripheral oxygen saturation (SpO₂) recorded from induction until successful endotracheal intubation. Secondary outcomes include the incidence of oxygen desaturation (\<90%), duration of apnea, duration of laryngoscopy, intubation time, number of intubation attempts, and peri-intubation complications. The study will determine whether HFNC provides superior oxygenation compared with conventional face mask preoxygenation during RSI and may contribute to improving airway management protocols and patient safety.
Rapid sequence induction (RSI) is the preferred technique for securing the airway in patients at risk of aspiration. Despite standardized airway management protocols, hypoxemia during the apneic period remains one of the most frequent and clinically important complications of RSI. Oxygen desaturation may lead to serious adverse events including cardiac arrhythmias, hemodynamic instability, cardiac arrest, neurological injury, and increased mortality. Effective preoxygenation before induction is therefore essential to maximize oxygen reserves and prolong safe apnea time.
Conventional preoxygenation is commonly performed using a tight face mask delivering 100% oxygen. Although this method is widely accepted, oxygen delivery is interrupted when the face mask is removed for laryngoscopy, potentially reducing oxygen reserves during prolonged intubation attempts. High-Flow Nasal Cannula (HFNC) delivers heated and humidified oxygen at high flow rates with a high inspired oxygen fraction while allowing continuous oxygen administration throughout laryngoscopy and apnea. HFNC also generates low-level positive airway pressure and facilitates clearance of upper airway dead space, which may improve oxygenation during rapid sequence induction.
Previous randomized trials and systematic reviews have produced inconsistent findings regarding the comparative effectiveness of HFNC and conventional face mask preoxygenation. Some studies have demonstrated prolonged safe apnea time and improved oxygenation with HFNC, whereas others have shown similar oxygen saturation between both techniques. Additional randomized controlled trials are required to determine whether HFNC provides clinically meaningful advantages in adult patients undergoing rapid sequence induction.
This single-center, prospective, parallel-group, randomized controlled trial will be conducted at the Department of Anesthesiology, Khyber Teaching Hospital, Peshawar. Eligible adult patients requiring rapid sequence induction for endotracheal intubation in the operating room, emergency department, or intensive care unit will be enrolled after providing informed consent. Participants will be randomly assigned in a 1:1 ratio to receive either High-Flow Nasal Cannula or Tight Face Mask preoxygenation using a computer-generated randomization sequence with allocation concealment through sequentially numbered, opaque, sealed envelopes.
Patients allocated to the intervention group will receive heated, humidified oxygen via High-Flow Nasal Cannula at the protocol-defined flow rate and fraction of inspired oxygen before induction and throughout laryngoscopy until successful endotracheal intubation. Participants allocated to the control group will receive conventional preoxygenation using a tightly fitting face mask delivering 100% oxygen according to standard institutional practice until induction of anesthesia.
The primary outcome will be the lowest peripheral oxygen saturation (SpO₂) recorded from induction until successful tracheal intubation. Secondary outcome measures will include the incidence of oxygen desaturation below 90%, duration of apnea, duration of laryngoscopy, time required for successful intubation, first-pass intubation success, number of intubation attempts, and peri-intubation adverse events including hypotension, arrhythmias, aspiration, and cardiac arrest.
Data will be collected prospectively using standardized case report forms by trained investigators. Statistical analyses will follow the intention-to-treat principle. Continuous variables will be compared using the independent-samples t-test or Mann-Whitney U test as appropriate, whereas categorical variables will be compared using the Chi-square test or Fisher's exact test. A two-sided p-value of less than 0.05 will be considered statistically significant.
The results of this trial are expected to provide high-quality evidence regarding the optimal preoxygenation strategy during rapid sequence induction and may contribute to improved airway management protocols and reduction of peri-intubation hypoxemia in adult patients.
1,076 studies on the registry are indexed under Hypoxia; 213 are open to participants now.
This study's planned enrollment of 290 is above the median of 45 across 769 interventional studies indexed under Hypoxia.
Browse Hypoxia studies →Khyber Teaching Hospital is the lead sponsor of 29 studies on the registry; 19 are open to participants now.
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Exclusion Criteria:
Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
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A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Informed consent
Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.
You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Contraindication
A reason a treatment, test or procedure should not be given to a particular person, such as an allergy, another illness or a medicine they take.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Hypersensitivity
An allergy, or another reaction of the immune system, to a substance. “Hypersensitivity to the study drug” means a known allergic reaction to it — not every side effect a medicine can have.
Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.
Participants randomized to this arm will receive preoxygenation using a heated, humidified high-flow nasal cannula delivering oxygen at 60 L/min with an FiO₂ of 100% for 3 minutes before rapid sequence induction. The HFNC will remain in place during induction and laryngoscopy until successful endotracheal intubation to provide continuous oxygenation throughout the apneic period.
Device: High-Flow Nasal Cannula
Participants randomized to this arm will receive standard preoxygenation using a tightly fitting anesthesia face mask delivering 100% oxygen at 15 L/min for 3 minutes before rapid sequence induction. The face mask will be removed immediately before laryngoscopy according to routine clinical practice. These arm titles and descriptions are appropriate for ClinicalTrials.gov registration. The next step will be to link each arm to its corresponding Device Intervention (HFNC and Tight Face Mask).
Device: Tight Face Mask
Participants assigned to this intervention will receive preoxygenation using a heated, humidified high-flow nasal cannula delivering oxygen at a flow rate of 60 L/min with an inspired oxygen fraction (FiO₂) of 1.0 (100%) for 3 minutes before rapid sequence induction. Oxygen delivery will be continued throughout the apneic period and laryngoscopy until successful endotracheal intubation.
Also known as: High-Flow Nasal Oxygen (HFNO)
Participants assigned to this intervention will receive standard preoxygenation using a tightly fitting anesthesia face mask delivering 100% oxygen at a flow rate of 15 L/min for 3 minutes before rapid sequence induction. The face mask will be removed immediately before laryngoscopy in accordance with standard clinical practice.
Lowest Peripheral Oxygen Saturation (SpO₂) During Rapid Sequence Induction
Time frame: Periprocedural (during rapid sequence induction, from induction of anesthesia until successful endotracheal intubation; approximately 5 minutes).
Incidence of Oxygen Desaturation
Time frame: Periprocedural (during rapid sequence induction, from induction of anesthesia until successful endotracheal intubation; approximately 5 minutes).
No study locations are listed for this record.
Start is estimated for Aug 2026; primary completion for Feb 2027, 6 months later.
Of 321 non-industry interventional studies with no phase under Hypoxia, half reached primary completion within 12 months of starting (the median), counting those still running; a quarter within 4 and three quarters within 27. This study's planned 6 months is below that.
Counting every sponsor, half of 351 studies reached it within 12 months; a quarter within 3 and three quarters within 27.
How these figures are worked out, and which studies are left out of them.
This study is not yet recruiting, as verified in Jul 2026. You cannot join it, but the record below documents what was studied.
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Khyber Teaching Hospital