A safety checklist for apnoeic oxygenation using high-flow nasal oxygen for laryngotracheal surgery in adults

BACKGROUND Apnoeic oxygenation using high-flow nasal oxygen is becoming a commonly used technique in adult patients undergoing laryngotracheal surgery. Despite widespread adoption, there are no best practice guidelines governing its safe delivery. OBJECTIVE To develop a checklist for use during laryngotracheal surgery to guide the safe delivery of apnoeic oxygenation using high-flow nasal oxygen. DESIGN Recognised experts in the field of apnoeic oxygenation were invited to participate in a Delphi process to establish essential items for inclusion in the safety checklist. An online Delphi survey platform was used to facilitate this process. SETTING A panel of 36 experts was assembled from 11 countries. They participated voluntarily in an 8-week Delphi process that included one preliminary round, two electronic voting rounds and a final virtual roundtable discussion. A small steering group was responsible for leading the Delphi process, collating the electronic voting responses, analysing the results and compiling the final checklist. MAIN OUTCOME MEASURES The consensus threshold for inclusion/exclusion of items in the safety checklist was set at at least 80% for the first and second electronic voting rounds. The consensus threshold was set at 70% for the final roundtable discussion. RESULTS The final checklist comprises 19 items, sub-divided into pre-procedure, peri-procedure and post-procedure aspects of patient care. The Delphi process was well attended, with an expert attrition rate of only 6%. A number of items reached more than 90% consensus, including the requirement to establish patients’ suitability for the technique in advance of surgery and preparedness for the immediate implementation of an agreed individualised rescue oxygenation strategy. CONCLUSION A Delphi process involving international experts has formulated a 19-item checklist for guiding the safe delivery of apnoeic oxygenation using high-flow nasal oxygen in adult patients undergoing laryngotracheal surgery. Further studies are required to assess the effects of this checklist on patient safety and outcomes.