Brainard Andrew, Chuang Danny, Zeng Irene, Larkin G Luke
Middlemore Hospital, Auckland, New Zealand; University of Auckland Medical School, Auckland, New Zealand.
Middlemore Hospital, Auckland, New Zealand.
Ann Emerg Med. 2015 Apr;65(4):356-61. doi: 10.1016/j.annemergmed.2014.10.023. Epub 2014 Nov 20.
Experts advocate the use of a standard nasal cannula to provide oxygen at flow rates of up to 15 L/minute during emergency intubation. However, because of concerns about potential patient discomfort, some providers avoid providing nasal cannula oxygen at flow rates greater than 6 L/minute. This trial is designed to determine the participants' ability to tolerate 10 minutes of nasal cannula oxygen at higher flow rates.
This was a prospective, randomized, crossover trial of healthy volunteers at an emergency department in New Zealand. Participants were randomized to first receive either higher-flow (15 L/minute) or lower-flow (6 L/minute) nasal cannula oxygen for 10 minutes. After a 1-hour washout period, they received the alternate flow rate for 10 minutes. The primary outcome was the ability to tolerate 10 minutes of the nasal cannula oxygen at each flow rate. The secondary outcome was the difference in discomfort between the flow rates as measured on a 100-mm visual analog scale.
All 77 of the participants (100%) were able to tolerate 10 minutes at both flow rates. Participants rated the higher-flow nasal cannula oxygen as a mean of 25 mm (SD 20 mm) more uncomfortable than the lower-flow nasal cannula oxygen. One minute after the oxygen was discontinued, the mean difference in discomfort between the flow rates was a clinically insignificant 9.8 mm (SD 17 mm) more uncomfortable. There were no adverse events.
Participants were able to tolerate higher-flow nasal cannula oxygen for 10 minutes without difficulty. Higher-flow nasal cannula oxygen at 15 L/minute was associated with some discomfort, but the discomfort quickly dissipated and caused no adverse events.
专家提倡在紧急插管期间使用标准鼻导管以高达15升/分钟的流速提供氧气。然而，由于担心可能给患者带来不适，一些医护人员避免以高于6升/分钟的流速通过鼻导管提供氧气。本试验旨在确定参与者耐受较高流速鼻导管给氧10分钟的能力。
这是一项在新西兰一家急诊科对健康志愿者进行的前瞻性、随机、交叉试验。参与者被随机分为先接受10分钟的高流速（15升/分钟）或低流速（6升/分钟）鼻导管给氧。在1小时的洗脱期后，他们接受另一种流速给氧10分钟。主要结局是在每种流速下耐受10分钟鼻导管给氧的能力。次要结局是通过100毫米视觉模拟量表测量的两种流速下不适程度的差异。
所有77名参与者（100%）都能在两种流速下耐受10分钟。参与者对高流速鼻导管给氧的舒适度评分平均比低流速鼻导管给氧高25毫米（标准差20毫米）。停止给氧1分钟后，两种流速下不适程度的平均差异在临床上无显著意义，高流速比低流速仅高9.8毫米（标准差17毫米）。未发生不良事件。
参与者能够毫无困难地耐受高流速鼻导管给氧10分钟。15升/分钟的高流速鼻导管给氧会带来一些不适，但这种不适很快消散，且未引起不良事件。
