Tanoubi I, Drolet P, Fortier L P, Donati F
Département d'anesthésie, hôpital Maisonneuve-Rosemont, centre hospitalier, université de Montréal, 5415, boulevard de l'Assomption, Montréal, QC, Canada, H1T 2M4.
Ann Fr Anesth Reanim. 2010 Mar;29(3):198-203. doi: 10.1016/j.annfar.2009.11.009. Epub 2010 Feb 8.
Applying an inspiratory support (AI) and a positive end expiratory pressure (PEP) could increase the effectiveness of the preoxygenation.
This randomized double blinded controlled study compares the impact on the expiratory oxygen fraction (FEO(2)) of two levels of AI with PEP to a traditional preoxygenation.
Twenty healthy volunteers were studied. The criteria of exclusion were a body mass index >30, the presence of beard or moustache and the claustrophobia. Each subject went through three modes of preoxygenation during 3 minutes each in a random order: 1-spontaneous ventilation (VS), 2-preoxygenation with AI with 4 cmH(2)O/PEP 4 cmH(2)O (AI-4/PEP-4), 3-preoxygenation with AI with 6 cmH(2)O/PEP 4 cmH(2)O (AI-6/PEP-4). Subject's tolerance and leaks were also noted.
The FEO(2) at the end of the 3 minutes of preoxygenation was higher (p<0,001) with AI-4/PEP-4 (94+/-3%) and AI-6/PEP-4 (94+/-4%) than with technique VS (89+/-6%). One hundred percent and 90% of the participants reached one FEO(2)=90% with AI-4/PEP-4 and AI-6/PEP-4 respectively vs 65% with VS (p=0.0013). The participants tolerated better the VS and the AI-4/PEP-4 than the AI-6/PEP-4. More leaks were noted with the AI-6/PEP-4 than with the VS and the AI-4/PEP-4.
This study shows applying AI plus PEP during preoxygenation improves its effectiveness in the healthy subjects. It also suggests that, in a population of healthy volunteers, combination AI-4/PEP-4 is preferable to AI-6/PEP-4 because so effective, but better tolerated.
应用吸气支持（AI）和呼气末正压（PEP）可提高预充氧的效果。
这项随机双盲对照研究比较了两种AI水平加PEP与传统预充氧对呼气末氧分数（FEO₂）的影响。
研究了20名健康志愿者。排除标准为体重指数>30、有胡须或小胡子以及幽闭恐惧症。每位受试者以随机顺序在3分钟内经历三种预充氧模式：1-自主通气（VS），2-AI 4 cmH₂O/PEP 4 cmH₂O预充氧（AI-4/PEP-4），3-AI 6 cmH₂O/PEP 4 cmH₂O预充氧（AI-6/PEP-4）。还记录了受试者的耐受性和漏气情况。
预充氧3分钟结束时，AI-4/PEP-4（94±3%）和AI-6/PEP-4（94±4%）组的FEO₂高于技术VS组（89±6%）（p<0.001）。分别有100%和90%的参与者在AI-4/PEP-4和AI-6/PEP-4组达到FEO₂=90%，而VS组为65%（p=0.0013）。参与者对VS和AI-4/PEP-4的耐受性优于AI-6/PEP-4。与VS和AI-4/PEP-4相比，AI-6/PEP-4组的漏气情况更多。
本研究表明在预充氧期间应用AI加PEP可提高其在健康受试者中的效果。还表明，在健康志愿者群体中，AI-4/PEP-4组合优于AI-6/PEP-4，因为其效果显著且耐受性更好。
