Evaluation of the Efficacy and Safety of High-Flow Oxygen Therapy Compared With a Nasal Positive Airway Pressure (nPAP) Mask Using Transcutaneous Capnometry During Endoscopic Procedures in High-Risk Patients (HiPERion)

November 6, 2026 updated by: Thomas Seufferlein, University of Ulm

The HiPERion Trial is a prospective, randomized, controlled, non-inferiority study designed to compare the efficacy and safety of two oxygen and respiratory support methods during sedated endoscopic procedures in patients at increased risk of respiratory complications.

Patients with significant pre-existing medical conditions (American Society of Anesthesiologists [ASA] physical status III or IV) have an increased risk of breathing-related complications during endoscopic procedures performed under sedation. These complications include low blood oxygen levels (hypoxemia) and elevated carbon dioxide levels in the blood (hypercapnia).

The study will compare two respiratory support methods: high-flow nasal cannula (HFNC) oxygen therapy and a nasal positive airway pressure (nPAP) system using the SuperNO2VA mask. Both methods are used to support breathing and maintain adequate oxygen levels during medical procedures. However, they differ in their technical approach and in the way they support ventilation.

A total of 140 adult patients undergoing diagnostic or therapeutic endoscopic procedures lasting more than 15 minutes will be enrolled at the University Hospital Ulm, Germany. Eligible participants will be randomly assigned to receive either HFNC oxygen therapy or respiratory support via the nPAP mask during the procedure.

Throughout the endoscopic procedure, patients will receive standard clinical monitoring, including measurement of oxygen saturation, heart rate, and blood pressure. In addition, carbon dioxide levels will be continuously monitored using a non-invasive transcutaneous capnometry sensor attached to the patient's forehead. This method allows continuous measurement of carbon dioxide levels through the skin without the need for additional blood sampling.

The primary objective is to compare the occurrence of hypoxemic events between the two respiratory support methods. Hypoxemia is defined as a decrease in oxygen saturation below 90% lasting more than 10 seconds. Severe hypoxemic events, defined as a decrease in oxygen saturation below 80% lasting more than 10 seconds, will also be assessed.

Secondary objectives include comparing changes in transcutaneous carbon dioxide levels during the procedure, the number of interventions required to maintain an open airway or optimize respiratory support, and the occurrence of adverse events.

The study aims to determine whether respiratory support using the nPAP mask is not inferior to HFNC oxygen therapy in terms of safety and prevention of hypoxemic events during endoscopic procedures in high-risk patients. The findings may help identify an effective and safe respiratory support strategy for this patient population.

Study Overview

Status

Enrolling by invitation

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

140

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Germany
      • Ulm, Germany, 89081
        • University Hospital Ulm

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adults aged 18 years or older.
  • American Society of Anesthesiologists (ASA) physical status III or IV.
  • Patients undergoing diagnostic or therapeutic endoscopic procedures with an expected duration of more than 15 minutes.
  • Written informed consent to participate in the study.

Exclusion Criteria:

  • Patients unable or unwilling to provide informed consent.
  • Known pregnancy.
  • Intolerance or contraindications to sedation.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: HFNC Group

High-Flow Nasal Cannula (HFNC) Oxygen Therapy
Device: High-Flow Nasal Cannula (HFNC) Oxygen Therapy

Patients assigned to the HFNC group will receive high-flow nasal cannula oxygen therapy during the endoscopic procedure. The oxygen flow rate will be set at 40 L/min with an inspired oxygen concentration (FiO₂) of 40%. Transcutaneous carbon dioxide levels will be continuously monitored using a non-invasive forehead sensor. Standard monitoring of peripheral oxygen saturation (SpO₂), heart rate, and blood pressure will be performed throughout the procedure.
Active Comparator: nPAP Group

Nasal Positive Airway Pressure (nPAP) Using the SuperNO2VA Mask
Device: nPAP

Patients assigned to the nPAP group will receive respiratory support using a nasal positive airway pressure (nPAP) system with the SuperNO2VA nasal mask throughout the endoscopic procedure. Transcutaneous carbon dioxide levels will be continuously monitored using a non-invasive forehead sensor. Standard monitoring of peripheral oxygen saturation (SpO₂), heart rate, and blood pressure will be performed throughout the procedure.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Number of Hypoxemic Events
Time Frame: During the endoscopic procedure.

Number of hypoxemic events, defined as a peripheral oxygen saturation (SpO₂) below 90% lasting more than 10 seconds, during the endoscopic procedure.
During the endoscopic procedure.
Number of Severe Hypoxemic Events
Time Frame: During the endoscopic procedure.

Number of severe hypoxemic events, defined as a peripheral oxygen saturation (SpO₂) below 80% lasting more than 10 seconds, during the endoscopic procedur
During the endoscopic procedure.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Transcutaneous Carbon Dioxide Levels (tcPCO₂)
Time Frame: During the endoscopic procedure.

Difference between the initial transcutaneous carbon dioxide level (tcPCO₂) and the mean tcPCO₂ level measured during the endoscopic procedure. Continuous non-invasive monitoring will be performed using a transcutaneous forehead sensor.
During the endoscopic procedure.
Number of Airway Support Interventions
Time Frame: During the endoscopic procedure.

Number of airway support interventions required during the endoscopic procedure, including head repositioning and repositioning or adjustment of the nPAP mask or HFNC nasal cannula.
During the endoscopic procedure.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

University of Ulm

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

October 13, 2026

Primary Completion (Estimated)

March 13, 2027

Study Completion (Estimated)

June 13, 2027

Study Registration Dates

First Submitted

November 6, 2026

First Submitted That Met QC Criteria

November 6, 2026

First Posted (Actual)

November 12, 2026

Study Record Updates

Last Update Posted (Actual)

November 12, 2026

Last Update Submitted That Met QC Criteria

November 6, 2026

Last Verified

October 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 20/25 FSt/Sta Ulm

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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