High-flow versus standard nasal cannula oxygenation for post-procedural quality of recovery in older adults undergoing sedated ERCP: protocol for a randomized controlled trial

Introduction Endoscopic retrograde cholangiopancreatography (ERCP) in older adults is frequently complicated by intra-procedural desaturation and inflammation, delaying recovery. We compare high-flow nasal cannula (HFNC) oxygenation with standard therapy for improving post-procedural recovery quality and attenuating inflammation.Patients and Methods This single-center, prospective, randomized, patient- and assessor-blinded, parallel-group trial will enroll 106 in-patients aged ≥ 70 years scheduled for elective ERCP under sedation. Following esketamine 0.25 mg/kg and propofol target-controlled infusion (plasma concentration 2.5 µg/mL), patients will be randomly allocated (1:1) to receive either HFNC oxygenation (40 L/min, 100% O2, 37 °C) or standard nasal cannula oxygenation (5 L/min). The primary endpoint is quality of recovery at 24 h post-procedure, assessed using the 15-item Quality of Recovery (QoR-15) scale. Secondary endpoints include the incidence of desaturation (SpO2 < 90% for ≥ 10 s), time to emergence, serum inflammatory biomarkers, and post-procedural morbidity. Analyses will follow the intention-to-treat principle, with adjustment for prespecified covariates using a generalized linear model.Discussion We hypothesize that HFNC oxygenation will improve 24-h QoR-15 scores, reduce intra-procedural desaturation, and attenuate systemic inflammatory response compared with standard nasal cannula oxygenation. The findings will inform evidence-based respiratory support strategies during ERCP in older adults.Trial registration Chinese Clinical Trial Registry (Identifier: ChiCTR2500105743)