Rajan Sunil, Joseph Nandhini, Tosh Pulak, Kadapamannil Dilesh, Paul Jerry, Kumar Lakshmi
Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Indian J Anaesth. 2018 Mar;62(3):202-207. doi: 10.4103/ija.IJA_717_17.
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) during apnoea has shown to delay desaturation. The primary objective was to compare time to desaturate to <90% during apnoea with THRIVE versus traditional preoxygenation followed by apnoeic oxygenation.
This prospective, randomised, single-blinded study was conducted in 10 adult patients presenting for direct laryngoscopy under general anaesthesia without endotracheal intubation. Group P patients were preoxygenated with 100% oxygen, and in Group H, high-flow humidified oxygen was delivered using nasal cannula for 3 min. After induction and neuromuscular blockade, time to desaturate to 90%, while receiving apnoeic oxygenation, was noted. Chi-square test and Mann-Whitney tests were used.
Group H had a significantly longer apnoea time as compared to Group P (796.00 ± 43.36 vs. 444.00 ± 52.56 s). All patients in Group H continued to have nearly 100% saturation even at 12 min of apnoea. However, in Group P, 80% of patients desaturated to <90% after 6 min of apnoea. Baseline blood gases, that following preoxygenation and at 3 min of apnoea time were comparable in both groups. At 6 min, Group H had a significantly higher PaO (295.20 ± 122.26 vs. 135.00 ± 116.78) and PaCO (69.46 ± 7.15 vs. 59.00 ± 4.64). Group H continued to have a PaO of >200 mmHg even at 12 min of apnoea with a significant rise in PaCO along with fall in pH after 6 min.
During apnoeic periods time to desaturate to <90% was significantly prolonged with use of THRIVE.
在呼吸暂停期间，经鼻湿化快速充气通气交换（THRIVE）已显示出可延迟血氧饱和度下降。主要目的是比较在呼吸暂停期间，使用THRIVE与传统预充氧后进行呼吸暂停氧合时，血氧饱和度降至<90%的时间。
本前瞻性、随机、单盲研究纳入了10例在全身麻醉下行直接喉镜检查且不进行气管插管的成年患者。P组患者用100%氧气进行预充氧，H组患者使用鼻导管输送高流量湿化氧气3分钟。诱导和神经肌肉阻滞之后，记录在接受呼吸暂停氧合时血氧饱和度降至90%的时间。采用卡方检验和曼-惠特尼检验。
与P组相比，H组的呼吸暂停时间显著更长（796.00±43.36秒对444.00±52.56秒）。H组所有患者即使在呼吸暂停12分钟时仍保持近100%的血氧饱和度。然而，在P组中，80%的患者在呼吸暂停6分钟后血氧饱和度降至<90%。两组的基线血气、预充氧后的血气以及呼吸暂停3分钟时的血气相当。在6分钟时，H组的动脉血氧分压显著更高（295.20±122.26对135.00±116.78），动脉血二氧化碳分压也更高（69.46±7.15对59.00±4.64）。即使在呼吸暂停12分钟时，H组的动脉血氧分压仍>200 mmHg，动脉血二氧化碳分压在6分钟后显著升高，同时pH值下降。
在呼吸暂停期间，使用THRIVE可显著延长血氧饱和度降至<90%的时间。
