Zekeriya ERVATAN, Nihan ALTINTEPE BAŞKURT, Serencan ÖZALP, Melike DUMAN, Mehmet Emin GÜRBÜZ, Mehmet Atilla UYSAL, Namigar TURGUT
Türk Geriatri Dergisi - 2026;29(3):344-357
Introduction: Sedated endoscopic retrograde cholangiopancreatography is associated with hypoxaemia and haemodynamic instability, particularly in geriatric patients. High-flow nasal oxygen may improve oxygenation compared with conventional oxygen therapy, yet its benefits in elderly patients undergoing endoscopic retrograde cholangiopancreatography remain unclear. Materials and Method: In this prospective randomized study, 100 adult patients undergoing elective endoscopic retrograde cholangiopancreatography were randomly assigned (1:1) to receive either High-flow nasal oxygen (50L·min?¹ with FiO2 0.50) or conventional oxygen therapy (4L/min.). Patients were randomly allocated into four groups: Group I:Adult (<65 years)+High-flow nasal oxygen, n=25 ), Group II:Geriatric (>=65 years)+High-flow nasal oxygen, n=25), Group III:Adult (<65 years) + conventional oxygen therapy, n=25), Group IV: Geriatric (>=65 years)+conventional oxygen therapy, n=25). The primary outcomes were hypoxaemia (SpO2<=90%) and hypotension (systolic arterial pressure <90 mmHg or >=20% decrease from baseline). Secondary outcomes included haemodynamic variables, end-tidal CO2, sedative consumption, and recovery time. Results: High-flow nasal oxygen significantly reduced hypoxaemic events, particularly in geriatric patients (p<0.05). SpO2 values remained more stable in the elderly High-flow nasal oxygen group, especially at the 15th and 30th minutes. End-tidal CO2 remained within physiological ranges in all groups. Systolic arterial pressure decreased in all groups at 5 minutes; reductions were more pronounced in geriatric patients irrespective of oxygenation strategy. Recovery time was shorter in adults receiving High-flow nasal oxygen (p<0.05). Conclusion: High-flow nasal oxygen improves oxygenation and reduces hypoxaemia during sedated endoscopic retrograde cholangiopancreatography, with the greatest benefit observed in geriatric patients. However, advanced age remains an independent risk factor for haemodynamic instability. Careful sedative titration and close monitoring are essential in elderly patients.
