自主经面罩呼吸预吸氧与高流量鼻氧法的比较：一项健康志愿者的随机对照交叉研究。
Comparison of pre-oxygenation using spontaneous breathing through face mask and high-flow nasal oxygen: A randomised controlled crossover study in healthy volunteers.
机构信息
From the Department of Anaesthesia and Intensive Care Medicine, Caen University Hospital, Caen, France.
出版信息
Eur J Anaesthesiol. 2019 May;36(5):335-341. doi: 10.1097/EJA.0000000000000954.
BACKGROUND
High-flow nasal oxygen (HFNO) therapy has been proposed for pre-oxygenation before intubation, but the end-tidal fraction of oxygen (ETO2) obtained remains unknown.
OBJECTIVE(S): To compare the ETO2 following a 3 min pre-oxygenation with HFNO and face mask.
SETTING
Operating room in a primary university hospital.
DESIGN
A randomised crossover study.
PARTICIPANTS
Fifty healthy volunteers.
INTERVENTIONS
Participants were randomly pre-oxygenated through spontaneous breathing 100% oxygen in a face mask and with HFNO (mouth closed, heated and humidified gas flow at 60 l min). In the face mask group, the ETO2 was measured continuously. In the HFNO group, the nasal cannula was quickly exchanged with a face mask while the subject held their breath at end inspiration and the ETO2 was measured after a deep expiration. The protocol ended when ETO2 reached 90% or otherwise at 6 min.
MAIN OUTCOME MEASURES
The primary endpoint was the ETO2 after 3 min of pre-oxygenation. Secondary endpoints were the proportion of participants with an ETO2 at least 90% and the time until the ETO2 at least 90%.
RESULTS
The ETO2 after 3 min of pre-oxygenation was 89 (2) % and 77 (12) % in the face mask and HFNO groups [difference 12% (95% confidence interval, 95% CI: 8 to 15]; P < 0.001), respectively. After 3 min of pre-oxygenation, 54 and 4% (P < 0.001) of volunteers had an ETO2 at least 90% in the face-mask and HFNO groups, respectively. After 6 min of pre-oxygenation, 96 and 46% (P < 0.001) of volunteers had an ETO2 at least 90% in the face-mask and HFNO groups, respectively. In the face mask group, the hazard ratio to achieve an ETO2 of 90% was 5.3 (95% CI: 3.2 to 8.9; P < 0.001).
CONCLUSION
Our study demonstrates that pre-oxygenation with HFNO is not a reliable method of pre-oxygenation before the induction of anaesthesia.
TRIAL REGISTRATION
clinical trial NCT03399695.
背景
高流量鼻氧（HFNO）治疗已被提议用于插管前预充氧，但获得的呼气末氧分数（ETO2）仍不清楚。
目的
比较 HFNO 和面罩预充氧 3 分钟后 ETO2 的差异。
地点
一所主要大学医院的手术室。
设计
随机交叉研究。
参与者
50 名健康志愿者。
干预措施
参与者通过自主呼吸 100%氧气进行预充氧，使用面罩和 HFNO（闭口，加热和加湿气体流速为 60 l/min）。在面罩组中，连续测量 ETO2。在 HFNO 组中，当受试者在吸气末屏住呼吸时，快速将鼻导管更换为面罩，然后在深呼气后测量 ETO2。当 ETO2 达到 90%或 6 分钟时，试验结束。
主要观察指标
主要终点为预充氧 3 分钟后的 ETO2。次要终点为至少有 90%ETO2 的参与者比例和达到至少 90%ETO2 的时间。
结果
面罩组和 HFNO 组预充氧 3 分钟后的 ETO2 分别为 89（2）%和 77（12）%[差异 12%（95%置信区间，95%CI：8 至 15]；P<0.001]。面罩组和 HFNO 组分别有 54%和 4%（P<0.001）的志愿者在预充氧 3 分钟后 ETO2 至少达到 90%。面罩组和 HFNO 组分别有 96%和 46%（P<0.001）的志愿者在预充氧 6 分钟后 ETO2 至少达到 90%。面罩组达到 ETO2 90%的风险比为 5.3（95%CI：3.2 至 8.9；P<0.001）。
结论
我们的研究表明，HFNO 预充氧不是麻醉诱导前可靠的预充氧方法。
试验注册
临床试验 NCT03399695。
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