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)

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.