Georgescu M, Tanoubi I, Fortier L-P, Donati F, Drolet P
Département d'anesthesiologie, hôpital Maisonneuve-Rosemont, centre affilié à l'université de Montréal, 5415, boulevard de l'Assomption, Montréal (Québec) Canada, H1T 2M4.
Ann Fr Anesth Reanim. 2012 Sep;31(9):e161-5. doi: 10.1016/j.annfar.2012.05.003. Epub 2012 Jul 6.
The impact of non-invasive positive pressure ventilation (NIPPV), which is a combination of inspiratory positive airway pressure (IPAP) and positive end expiratory pressure (PEEP), on the effectiveness of preoxygenation in obese patients was evaluated.
Randomized, controlled, double blinded, crossover study comparing NIPPV vs. tidal volume breathing (TVB) with regard to the expiratory O(2) fraction (FeO(2)).
Thirty participants with body mass index (BMI) greater or equal to 30 kg/m(2) scheduled for elective surgery were included. Patients with facial hair, and airway anomalies were excluded. Each patient underwent 3 minutes 100% O(2) preoxygenation with the two following methods in a random order: 1: TVB; 2: NIPPV (4 cmH(2)O IPAP+4 cmH(2)O PEEP). Primary outcome was FeO(2) after 3 minutes. Secondary outcomes were the number of patients reaching FeO(2) greater or equal to 90%, tidal volume, respiratory rate, and patient comfort on a 4-point scale.
No differences between methods were found regarding the FeO(2) change with time or after 3 minutes (89 ± 6% with TBV vs. 91 ± 4% with NIPPV). FeO(2) greater or equal to 90% was reached more frequently with NIPPV (80%) than with TVB (60%) (P=0.008). Tidal volume (m ± SD) was larger throughout preoxygenation with TBV (837 ± 440 mL) than with NIPPV (744 ± 368 mL), (P=0.0005). Respiratory rate did not differ between regimens. Patient comfort was good and similar.
This study suggests that providing a positive pressure of 4 cmH(2)O throughout inspiration and expiration during preoxygenation in obese patients provided benefits with regard to the FeO(2).
评估无创正压通气（NIPPV，即吸气气道正压[IPAP]与呼气末正压[PEEP]的联合应用）对肥胖患者预充氧效果的影响。
一项随机、对照、双盲、交叉研究，比较NIPPV与潮气量呼吸（TVB）在呼气氧分数（FeO₂）方面的差异。
纳入30例计划接受择期手术、体重指数（BMI）大于或等于30kg/m²的参与者。排除有面部毛发和气道异常的患者。每位患者以随机顺序采用以下两种方法进行3分钟的100%氧气预充氧：1：TVB；2：NIPPV（4cmH₂O IPAP + 4cmH₂O PEEP）。主要结局指标为3分钟后的FeO₂。次要结局指标为FeO₂达到或等于90%的患者数量、潮气量、呼吸频率以及采用4分制评估的患者舒适度。
在FeO₂随时间变化或3分钟后，两种方法之间未发现差异（TVB组为89±6%，NIPPV组为91±4%）。NIPPV组（80%）达到FeO₂大于或等于90%的频率高于TVB组（60%）（P = 0.008）。在整个预充氧过程中，TVB组的潮气量（m±SD）（837±440mL）大于NIPPV组（744±368mL）（P = 0.0005）。不同方案之间呼吸频率无差异。患者舒适度良好且相似。
本研究表明，在肥胖患者预充氧期间，在吸气和呼气过程中均提供4cmH₂O的正压，在FeO₂方面具有益处。
