Lampotang Samsun, Gravenstein Nikolaus, Paulus David A, Gravenstein Dietrich
Departments of *Anesthesiology and †Neurosurgery, University of Florida College of Medicine; and Departments of ‡Mechanical and Aerospace Engineering and §Electrical and Computer Engineering, University of Florida College of Engineering, Gainesville, Florida.
Anesth Analg. 2005 Nov;101(5):1407-1412. doi: 10.1213/01.ANE.0000180215.50589.02.
In June 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommended: "As a general policy, use air or FiO2 at < or =30% for open delivery (consistent with patient needs)" to prevent surgical fires. One way to interpret JCAHO's recommendation is that 100% O2 should not be indiscriminately used, and anesthesia providers should have the ability, consistent with patient needs and their clinical judgment, to deliver sub-100% O2 with nasal cannulae. An auxiliary O2 flowmeter has a barbed outlet connector that offers a convenient means to connect a cannula to an anesthesia machine and is routinely used for open delivery of 100% O2. The auxiliary O2 flowmeter provides only 100% O2 and thus does not allow titration of the O2 concentration to patient needs and may increase the risk of surgical fires. This report clarifies the JCAHO recommendation and describes different means of addressing it that are based primarily on using the anesthesia machine to blend a sub-100% O2 gas mixture and delivering it via a nasal cannula. The options presented depend on the model and manufacturer of the anesthesia machine and allow delivery via nasal cannula of O2 concentrations that range from 21% to 100%.
2003年6月，医疗组织认证联合委员会（JCAHO）建议：“作为一项通用政策，在开放式分娩时使用空气或氧浓度（FiO2）≤30%（根据患者需求而定）”以预防手术火灾。对JCAHO建议的一种解读方式是，不应随意使用100%氧气，麻醉医护人员应具备根据患者需求和临床判断，通过鼻导管输送低于100%氧气的能力。辅助氧气流量计有一个带倒钩的出口接头，提供了一种将鼻导管连接到麻醉机的便捷方式，常用于开放式输送100%氧气。辅助氧气流量计仅提供100%氧气，因此无法根据患者需求调节氧气浓度，可能会增加手术火灾的风险。本报告阐明了JCAHO的建议，并描述了主要基于使用麻醉机混合低于100%的氧气混合气体并通过鼻导管输送来解决该问题的不同方法。所介绍的选项取决于麻醉机的型号和制造商，并允许通过鼻导管输送浓度范围为21%至100%的氧气。
