经鼻湿化快速充气流通气交换在儿童呼吸暂停期间的氧合作用：一项前瞻性随机对照试验。

Transnasal humidified rapid insufflation ventilatory exchange for oxygenation of children during apnoea: a prospective randomised controlled trial.

机构信息

Department of Anaesthesiology & Pain Therapy, Bern University Hospital, Inselspital, Freiburgstrasse 8, 3010 Bern, Switzerland.

出版信息

Br J Anaesth. 2018 Mar;120(3):592-599. doi: 10.1016/j.bja.2017.12.017. Epub 2018 Jan 27.

DOI:10.1016/j.bja.2017.12.017

PMID:29452816

Abstract

BACKGROUND

Transnasal humidified rapid insufflation ventilatory exchange (THRIVE) comprises the administration of heated, humidified, and blended air/oxygen mixtures via nasal cannula at rates of ≥2 litres kg min. The aim of this randomized controlled study was to evaluate the length of the safe apnoea time using THRIVE with two different oxygen concentrations (100% vs 30% oxygen) compared with standard low-flow 100% oxygen administration.

METHODS

Sixty patients, aged 1-6 yr, weighing 10-20 kg, undergoing general anaesthesia for elective surgery, were randomly allocated to receive one of the following oxygen administration methods during apnoea: 1) low-flow 100% oxygen at 0.2 litres kg min; 2) THRIVE 100% oxygen at 2 litres kg min; and 3) THRIVE 30% oxygen at 2 litres kg min. Primary outcome was time to desaturation to 95%. Termination criteria included SpO decreased to 95%, transcutaneous CO increased to 65 mmHg, or apnoea time of 10 min.

RESULTS

The median (interquartile range) [range] apnoea time was 6.9 (5.7-7.8) [2.8-10.0] min for low-flow 100% oxygen, 7.6 (6.2-9.1) [5.2-10.0] min for THRIVE 100% oxygen, and 3.0 (2.4-3.7) [0.2-5.3] min for THRIVE 30% oxygen. No significant difference was detected between apnoea times with low-flow and THRIVE 100% oxygen administration (P=0.15). THRIVE with 30% oxygen demonstrated significantly shorter apnoea times (P<0.001) than both 100% oxygen modalities. The overall rate of transcutaneous CO increase was 0.57 (0.49-0.63) [0.29-8.92] kPa min without differences between the 3 groups (P=0.25).

CONCLUSIONS

High-flow 100% oxygen (2 litres kg min) administered via nasal cannulas did not extend the safe apnoea time for children weighing 10-20 kg compared with low-flow nasal cannula oxygen (0.2 litres kg min). No ventilatory effect was observed with THRIVE at 2.0 litres kg min.

CLINICAL TRIAL REGISTRATION

NCT02979067.

摘要

背景

经鼻湿化高流量快速通气交换（THRIVE）通过鼻导管以≥2 升/千克/分钟的速度给予加热、加湿和混合的空气/氧气混合物。本随机对照研究的目的是评估使用 THRIVE 进行两种不同氧浓度（100%与 30%氧气）与标准低流量 100%氧气通气相比时安全无通气时间的长短。

方法

60 名年龄 1-6 岁、体重 10-20kg 的择期手术全麻患儿被随机分配在无通气期间接受以下一种氧给予方式：1）低流量 100%氧气，流速为 0.2 升/千克/分钟；2）THRIVE 100%氧气，流速为 2 升/千克/分钟；3）THRIVE 30%氧气，流速为 2 升/千克/分钟。主要结局是血氧饱和度降至 95%的时间。终止标准包括 SpO2 降至 95%、经皮二氧化碳升高至 65mmHg 或无通气时间达到 10 分钟。

结果

低流量 100%氧气、THRIVE 100%氧气和 THRIVE 30%氧气的中位（四分位间距）[范围]无通气时间分别为 6.9（5.7-7.8）[2.8-10.0]分钟、7.6（6.2-9.1）[5.2-10.0]分钟和 3.0（2.4-3.7）[0.2-5.3]分钟。低流量与 THRIVE 100%氧气通气之间的无通气时间无显著差异（P=0.15）。THRIVE 30%氧气的无通气时间明显短于两种 100%氧气方式（P<0.001）。3 组间经皮二氧化碳升高的总体速率无差异（0.57[0.49-0.63]kPa·min，P=0.25）。