Wong David T, Yee Amanda J, Leong Siaw May, Chung Frances
Department of Anesthesia, Toronto Western Hospital, University Health Network, University of Toronto, MC2-405, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
Department of Kinesiology, McMaster University, Hamilton, ON, Canada.
Can J Anaesth. 2017 Apr;64(4):416-427. doi: 10.1007/s12630-016-0802-z. Epub 2017 Jan 3.
During the process of tracheal intubation, patients are apneic or hypoventilating and are at risk of becoming hypoxemic. This risk is especially high in patients with acute or chronic respiratory failure and accompanying compromised respiratory reserve. To address this concern, apneic oxygenation can be administered during tracheal intubation to aid in maintaining arterial oxygen saturation. The objective of this narrative review is to examine the utilization of apneic oxygenation within the operating room, intensive care unit (ICU), emergency department, and pre-hospital settings and to determine its efficacy compared with controls.
For this narrative review, we obtained pertinent articles using MEDLINE (1946 to April 2016), EMBASE™ (1974 to April 2016), Google Scholar, and manual searches. Apneic oxygenation was administered using various techniques, including the use of nasal prongs, nasopharyngeal or endotracheal catheters, or laryngoscopes.
First, all 12 operating room studies showed that apneic oxygenation significantly prolonged the duration to, and incidence of, desaturation. Second, two of the five ICU studies showed a significantly smaller decline in oxygen saturation with apneic oxygenation, with three studies showing no statistically significant difference vs controls. Lastly, two emergency department or pre-hospital studies showed that the use of apneic oxygenation resulted in a significantly lower incidence of desaturation and smaller declines in oxygen saturation.
Sixteen of the 19 studies showed that apneic oxygenation prolongs safe apneic time and reduces the incidence of arterial oxygen desaturation. Overall, studies in this review show that apneic oxygenation prolongs the time to oxygen desaturation during tracheal intubation. Nevertheless, the majority of the studies were small in size, and they neither measured nor were adequately powered to detect adverse respiratory events or other serious rare complications. Prolonged apneic oxygenation (with its consequent hypercarbia) can have risks and should be avoided in patients with conditions such as increased intracranial pressure, metabolic acidosis, hyperkalemia, and pulmonary hypertension.
在气管插管过程中，患者会出现呼吸暂停或通气不足，并有发生低氧血症的风险。这种风险在急性或慢性呼吸衰竭以及伴有呼吸储备功能受损的患者中尤其高。为解决这一问题，可在气管插管期间进行无呼吸氧合，以帮助维持动脉血氧饱和度。本叙述性综述的目的是研究无呼吸氧合在手术室、重症监护病房（ICU）、急诊科和院前环境中的应用，并确定其与对照组相比的疗效。
对于本叙述性综述，我们使用MEDLINE（1946年至2016年4月）、EMBASE™（1974年至2016年4月）、谷歌学术搜索以及手工检索获取相关文章。无呼吸氧合采用了多种技术，包括使用鼻导管、鼻咽或气管内导管或喉镜。
首先，所有12项手术室研究均表明，无呼吸氧合显著延长了血氧饱和度下降的持续时间和发生率。其次，五项ICU研究中的两项显示，无呼吸氧合时血氧饱和度下降显著较小，三项研究显示与对照组无统计学显著差异。最后，两项急诊科或院前研究表明，使用无呼吸氧合导致血氧饱和度下降的发生率显著降低，且下降幅度较小。
19项研究中的16项表明，无呼吸氧合可延长安全无呼吸时间，并降低动脉血氧饱和度下降的发生率。总体而言，本综述中的研究表明，无呼吸氧合可延长气管插管期间血氧饱和度下降的时间。然而，大多数研究规模较小，既未测量也没有足够的能力检测不良呼吸事件或其他严重罕见并发症。长时间的无呼吸氧合（及其随之而来的高碳酸血症）可能存在风险，对于颅内压升高、代谢性酸中毒、高钾血症和肺动脉高压等患者应避免使用。
