在镇静状态下非插管患者行纤维支气管镜检查时呼气末二氧化碳监测的效果：一项随机对照研究。

Efficacy of End-Tidal Capnography Monitoring during Flexible Bronchoscopy in Nonintubated Patients under Sedation: A Randomized Controlled Study.

机构信息

Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan.

Department of Pulmonary Medicine, International University of Health and Welfare, School of Medicine, Tochigi, Japan.

出版信息

Respiration. 2018;96(4):355-362. doi: 10.1159/000489888. Epub 2018 Jun 28.

DOI:10.1159/000489888

PMID:29953986

Abstract

BACKGROUND

Although appropriate sedation is recommended during flexible bronchoscopy (FB), patients are at risk for hypoventilation due to inadvertent oversedation. End-tidal capnography is expected as an additional useful monitor for these patients during FB.

OBJECTIVES

The aim of this study was to evaluate the benefit of additional end-tidal capnography monitoring in reducing the incidence of hypoxemia during FB in patients under sedation.

METHODS

Patients undergoing FB under moderate sedation without tracheal intubation were randomly assigned to receive standard monitoring including pulse oximetry or additional capnography monitoring. Bronchoscopy examiners for the only capnography group were informed of apnea events by alarms and display of the capnography monitor.

RESULTS

A total of 185 patients were enrolled. Patient characteristics were well balanced between the two groups. Hypoxemia (at least one episode of pulse oximeter oxygen saturation [SpO2] < 90%) was observed in 27 out of 94 patients in the capnography group (29%) and in 42 out of 91 patients in the control group (46%; p = 0.014), resulting in an absolute risk difference of -17.4% (95% confidence interval, -31.1 to -3.7). In the capnography group, hypoxemia duration was shorter (20.4 vs. 41.7 s, p = 0.029), severe hypoxemic events (SpO2 < 85%) were observed less frequently (16 [17%] vs. 29 [32%], p = 0.019), and the mean lowest SpO2 value was higher (90.5 vs. 87.6%, p = 0.002).

CONCLUSION

End-tidal capnography monitoring can reduce the incidence and duration of hypoxemia during FB in nonintubated patients under sedation.

摘要

背景

虽然在进行软性支气管镜检查（FB）时建议进行适当的镇静，但由于意外过度镇静，患者可能存在通气不足的风险。呼气末二氧化碳监测预计将成为这些患者在 FB 期间的另一种有用的监测手段。

目的

本研究旨在评估在接受镇静的患者中，通过附加的呼气末二氧化碳监测来降低 FB 期间低氧血症的发生率。

方法

接受无气管插管的中度镇静下 FB 的患者被随机分为接受标准监测（包括脉搏血氧饱和度监测）或附加的二氧化碳监测。仅二氧化碳监测组的支气管镜检查医师通过警报和二氧化碳监测仪的显示，了解到呼吸暂停事件。

结果

共纳入 185 例患者。两组患者的特征均均衡。在二氧化碳监测组的 94 例患者中有 27 例（29%）和对照组的 91 例患者中有 42 例（46%）出现了低氧血症（至少有一次脉搏血氧饱和度 [SpO2] < 90%）（p = 0.014），绝对风险差异为-17.4%（95%置信区间，-31.1 至-3.7）。在二氧化碳监测组中，低氧血症持续时间更短（20.4 秒与 41.7 秒，p = 0.029），严重低氧血症事件（SpO2 < 85%）发生的频率较低（16 例[17%]与 29 例[32%]，p = 0.019），且平均最低 SpO2 值较高（90.5%与 87.6%，p = 0.002）。