Conventional low-flow oxygen therapy delivered through a nasal cannula can cause nasal dryness and discomfort. This study evaluated whether topical nasal moisturization with 0.9% isotonic saline nasal drops or a hyaluronic acid-based nasal spray could reduce nasal dryness in adults receiving low-flow oxygen therapy. In this prospective, randomized, three-arm clinical trial, 150 adults receiving conventional low-flow nasal oxygen therapy in a coronary intensive care unit were assigned to one of three groups: low-flow oxygen alone, low-flow oxygen plus 0.9% isotonic saline nasal drops, or low-flow oxygen plus a hyaluronic acid-based nasal spray. All participants received low-flow oxygen alone during the first 4 hours. After the 4-hour assessment, the assigned topical nasal interventions were started and continued until the 12-hour assessment. The primary outcome was patient-reported nasal dryness. Other assessments included patient comfort, nasal pain, clinician-assessed nasal mucosal dryness, nasal moisture measured using the intranasal Schirmer test, and epistaxis. Outcomes were assessed at 4 and 12 hours.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
150
Conventional low-flow oxygen therapy was administered via a standard nasal cannula according to the treating physician's clinical judgment and routine coronary intensive care practice.
Participants received topical nasal moisturization with 0.9% isotonic saline nasal drops in addition to conventional low-flow oxygen therapy. The nasal drops were administered after the 4-hour pre-intervention assessment and repeated at 7 and 10 hours. Final outcome assessment was performed at 12 hours.
Participants received topical nasal moisturization with a hyaluronic acid-based nasal spray (Hylonem®) containing sodium hyaluronate, sodium chloride, grapefruit seed extract, and purified water, in addition to conventional low-flow oxygen therapy. The nasal spray was administered after the 4-hour pre-intervention assessment. Final outcome assessment was performed at 12 hours.
Sultan Abdulhamid Han Training and Research Hospital
Istanbul, Istanbul, Turkey (Türkiye)
Patient-Reported Nasal Dryness
Patient-reported nasal dryness was assessed using a 10-cm visual analog scale (VAS), where 0 indicates no nasal dryness and 10 indicates the worst imaginable nasal dryness. Nasal dryness was assessed at 4 hours, before initiation of the assigned topical nasal intervention, and again at 12 hours.
Time frame: At 4 hours (pre-intervention baseline) and 12 hours
Patient Comfort
Patient comfort was assessed using a 10-cm visual analog scale (VAS), where 0 indicates the worst possible comfort and 10 indicates the best possible comfort.
Time frame: At 4 hours (pre-intervention baseline) and 12 hours
Patient-Reported Nasal Pain
Patient-reported nasal pain was assessed using a 10-cm visual analog scale (VAS), where 0 indicates no pain and 10 indicates the worst imaginable pain.
Time frame: At 4 hours (pre-intervention baseline) and 12 hours
Clinician-Assessed Nasal Mucosal Dryness
Nasal mucosal dryness was assessed by a clinician using a standardized four-point ordinal scale: 0 = none, 1 = mild, 2 = moderate, and 3 = severe.
Time frame: At 4 hours (pre-intervention baseline) and 12 hours
Intranasal Schirmer Test
Nasal surface moisture was objectively assessed using the intranasal Schirmer test. Schirmer strips were placed intranasally, and the length of strip wetting was recorded in millimeters (mm), with higher values indicating greater nasal surface moisture.
Time frame: At 4 hours (pre-intervention baseline) and 12 hours
Epistaxis
Epistaxis was assessed as the presence or absence of nasal bleeding at each assessment.
Time frame: At 4 hours (pre-intervention baseline) and 12 hours
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