一种新型内镜面罩的临床应用：一项针对清醒状态下行纤维支气管镜插管患者的随机对照多中心试验。

Clinical application of a novel endoscopic mask: a randomized controlled, multi-center trial in patients undergoing awake fiberoptic bronchoscopic intubation.

作者信息

Zou Tianxiao, Huang Zhenling, Hu Xiaoxue, Cai Guangyu, He Miao, Wang Shanjuan, Huang Ping, Yu Bin

机构信息

Department of Anesthesiology, Tongji Hospital affiliated to Tongji University, Shanghai, China. NO.389, Xincun Road, Putuo District, Shanghai, China.

Department of Anesthesiology, Renji Hospital affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

BMC Anesthesiol. 2017 Jun 15;17(1):79. doi: 10.1186/s12871-017-0370-y.

DOI:10.1186/s12871-017-0370-y

PMID:28619016

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5472943/

Abstract

BACKGROUND

Awake fiberoptic bronchoscopic tracheal intubation is usually regarded as an effective method in the management of predicted difficult airway. Hypoxia during awake nasal fiberoptic bronchoscopic intubation leads to discontinuation of the procedure, prolonged manipulation time and increased risk of severe complications. The main aim of the study was to test whether the novel endoscopic mask is helpful for hypoxia during the intubation.

METHODS

This was a randomized, controlled, multi-center study. 55 patients were recruited, but one patient was lost to follow-up. Finally, 54 patients (19 man and 35 women) were analyzed. After entering the operating room, nasal catheter oxygen-providing was given in the control group, and the treatment group received endoscopic mask oxygen-providing, with a flow rate of 3 L/min, lasting into the end of the intubation. Primary outcomes included mean arterial pressure, heart rate, minimum pulse oxygen saturation and incidence of pulse oxygen saturation ≤ 90%. Secondary outcomes included number of intubation attempts and time to intubation. All outcomes were finally measured.

RESULTS

Minimum pulse oxygen saturation during awake nasal fiberoptic bronchoscopic tracheal intubation was significantly higher in the endoscopic mask intubation group (91.7% ± 4.7%) than that the nasal catheter intubation group (87.6% ± 8.2%, P = 0.031. Furthermore, the incidence of pulse oxygen saturation ≤ 90% was significantly lower in the endoscopic mask intubation group (20.0%, 5/25) than that in the nasal catheter intubation group (51.7%, 15/29, P = 0.037). But mean arterial pressure of during intubation was significantly higher in the endoscopic mask group (100.0 ± 13.3 vs 90.3 ± 21.8, P = 0.049). In addition, there were no differences in the number of intubation attempts (P = 0.45) or time to intubation between the two groups (P = 0.38).

CONCLUSIONS

The endoscopic mask was safely used in awake fiberoptic bronchoscopic tracheal intubation, with advantages of stable blood pressure and potential prevention of desaturation. Beginners for the intubation procedure and patients at high risk of hypoxia could benefit from the use of the endoscopic mask.

TRIAL REGISTRATION

Trial registration: www.chictr.org.cn . Registration No.: ChiCTR-TRC-13004086. Date of Registration: 8th, Sep, 2013.

摘要

背景

清醒纤维支气管镜引导下气管插管通常被认为是处理预计困难气道的有效方法。清醒经鼻纤维支气管镜插管期间的低氧血症会导致操作中断、操作时间延长以及严重并发症风险增加。本研究的主要目的是测试新型内镜面罩在插管期间对低氧血症是否有帮助。

方法

这是一项随机、对照、多中心研究。共招募了55例患者，但有1例患者失访。最终，对54例患者（19例男性和35例女性）进行了分析。进入手术室后，对照组给予经鼻导管吸氧，治疗组给予内镜面罩吸氧，流速为3L/min，持续至插管结束。主要结局包括平均动脉压、心率、最低脉搏血氧饱和度以及脉搏血氧饱和度≤90%的发生率。次要结局包括插管尝试次数和插管时间。所有结局均进行了最终测量。

结果

清醒经鼻纤维支气管镜气管插管期间，内镜面罩插管组的最低脉搏血氧饱和度（91.7%±4.7%）显著高于经鼻导管插管组（87.6%±8.2%，P=0.031）。此外，内镜面罩插管组脉搏血氧饱和度≤90%的发生率（20.0%，5/25）显著低于经鼻导管插管组（51.7%，15/29，P=0.037）。但内镜面罩组插管期间的平均动脉压显著高于经鼻导管插管组（100.0±13.3 vs 90.3±21.8，P=0.049）。此外，两组间插管尝试次数（P=0.45）或插管时间（P=0.38）无差异。