在给氧和窒息操作期间，高保真 METI 人体患者模拟器生理模型的准确性如何？

What is the accuracy of the high-fidelity METI Human Patient Simulator physiological models during oxygen administration and apnea maneuvers?

机构信息

Service d'Anesthésie et de Réanimation Chirurgicale, Hôtel-Dieu Hôpital Mère Enfant, Place Alexis Ricordeau, Nantes, F-44000 France.

出版信息

Anesth Analg. 2013 Aug;117(2):392-7. doi: 10.1213/ANE.0b013e3182991c2d. Epub 2013 Jun 6.

DOI:10.1213/ANE.0b013e3182991c2d

PMID:23744955

Abstract

BACKGROUND

A widely used physiological simulator is generally accepted to give valid predictions of oxygenation status during disturbances in breathing associated with anesthesia. We compared predicted measures with physiological measurements available in the literature, or derived from other models.

METHODS

Five studies were selected from the literature which explored arterial oxygenation, with or without preoxygenation, in clinical situations or through mathematical modeling as well as the evolution of the fraction of expired oxygen (Feo2) during preoxygenation maneuvers. Scenarios from these studies were simulated on the METI-Human Patient Simulator™ simulator, and the data were compared with the results in the literature.

RESULTS

Crash-induction anesthesia without preoxygenation induces an O2 pulse saturation (Spo2) decrease that is not observed on the METI simulator. In humans, after 8 minutes of apnea, Spo2 decreased below 90% while the worst value was 95% during the simulation. The apnea time to reach 85% was less with obese patients than with healthy simulated patients and was shortened in the absence of preoxygenation. However, the data in the literature include METI simulator confidence interval 95% values only for healthy humans receiving preoxygenation. The decrease in Pao2 during 35-second apnea started at end-expiration was slower on the METI simulator than the values reported in the literature. Feo2 evolution during preoxygenation maneuvers on the METI simulator with various inspired oxygen fractions (100%, 92%, 84%, and 68%) was very close to those reported in humans when perfect mask seal is provided. In practice, this seal is impossible to obtain on the METI simulator.

CONCLUSIONS

Spo2 decreased much later during apnea on the METI simulator than in a clinical situation, whether preoxygenation was performed or not. The debriefing after simulation of critical situations or the use of the METI simulator to test a new equipment must consider these results.

摘要

背景

广泛使用的生理模拟器通常被认为可以对与麻醉相关的呼吸干扰期间的氧合状态进行有效预测。我们将预测结果与文献中可用的生理学测量值或从其他模型中得出的值进行了比较。

方法

从文献中选择了五项研究，这些研究探讨了临床情况下或通过数学建模以及预充氧期间呼气末氧分数（Feo2）演变情况下的动脉氧合作用，这些研究既有未预充氧的，也有预充氧的。将这些研究中的场景模拟到 METI-Human Patient Simulator™模拟器上，并将数据与文献中的结果进行了比较。

结果

未预充氧的诱导麻醉导致的 O2 脉冲饱和度（Spo2）下降在 METI 模拟器上并未观察到。在人类中，8 分钟的无通气后，Spo2 下降到 90%以下，而模拟时最差值为 95%。到达 85%的无通气时间在肥胖患者中比在健康模拟患者中更短，并且在没有预充氧的情况下更短。然而，文献中的数据仅包括接受预充氧的健康人类的 METI 模拟器置信区间 95%值。在 METI 模拟器上，35 秒无通气期间的 Pao2 下降从呼气末开始时较慢，而文献中的值则更快。在 METI 模拟器上，用各种吸入氧分数（100%、92%、84%和 68%）进行预充氧操作时，Feo2 的演变非常接近在人类中提供完美面罩密封时的情况。实际上，在 METI 模拟器上，这种密封是不可能实现的。