Abouzgheib Wissam, Ben-Jacob Talia K, Borah Amit, Terrigno Rocco, Cruz-Morel Karla, Dy Robert, Gratz Irwin, Boujaoude Ziad
Interventional Pulmonary Section, Cooper Medical School at Rowan University, Camden, New Jersey, USA.
Department of Anesthesiology, Cooper University Hospital, Camden, New Jersey, USA.
Biomed Hub. 2019 Aug 20;4(2):1-9. doi: 10.1159/000502110. eCollection 2019 May-Aug.
Endobronchial ultrasound (EBUS) procedures tend to be longer than routine bronchoscopies. Increased duration and sedative dosing put patients at increased risk for -hypoxic events.
To determine whether oxygen supplementation via a nasal trumpet connected to a Mapleson B circuit (NTM) was effective in decreasing hypoxic events when compared with the standard of care, oxygen supplementation with a nasal cannula (NC).
Patients referred for EBUS-guided transbronchial needle aspiration with monitored anesthesia care (MAC) were randomized 1:1 to NTM or to NC. Hypoxia-related procedural interruptions, the primary endpoint of the study, were documented for all patients. Patients in the NC group who had refractory desaturations were allowed to cross over to the NTM group. Secondary endpoints included: number of crossovers from NC to NTM, sedative dosing, total procedure times, whether procedure goals were achieved, complications apart from hypoxia, patient discharge status.
Fifty-two patients were randomized to NC and 48 to NTM. Baseline characteristics were comparable. The NC group had significantly more interruptions than did the NTM group ( < 0.001). Procedure duration was also significantly ( < 0.03) shorter for the NTM group. Fourteen patients were crossed over from NC to NTM because of hypoxia. Thirteen out of the 14 completed the procedure with no interruptions. All procedures were successfully completed, and all goals were achieved. All patients returned to baseline status prior to discharge. Three minor complications of epistaxis occurred.
For patients undergoing EBUS with MAC, oxygen supplementation with NTM significantly decreased the incidence of hypoxic events when compared with NC. NTM may also be of value for other subsets of patients who are at increased risk for desaturation when undergoing bronchoscopy.
支气管内超声（EBUS）检查往往比常规支气管镜检查耗时更长。检查时间延长和镇静剂用量增加使患者发生低氧事件的风险升高。
确定与标准护理措施即使用鼻导管吸氧（NC）相比，通过连接至Mapleson B回路的鼻喇叭吸氧（NTM）在减少低氧事件方面是否有效。
接受EBUS引导下经支气管针吸活检并采用监护麻醉（MAC）的患者按1:1随机分为NTM组或NC组。记录所有患者与低氧相关的检查中断情况，这是本研究的主要终点。NC组中出现难治性血氧饱和度降低的患者可转至NTM组。次要终点包括：从NC组转至NTM组的患者人数、镇静剂用量、总检查时间、检查目标是否达成、除低氧外的并发症、患者出院状态。
52例患者随机分为NC组，48例分为NTM组。基线特征具有可比性。NC组的中断情况显著多于NTM组（<0.001）。NTM组的检查持续时间也显著更短（<0.03）。14例患者因低氧从NC组转至NTM组。其中13例完成了检查且未出现中断。所有检查均成功完成，所有目标均达成。所有患者在出院前均恢复至基线状态。发生了3例鼻出血的轻微并发症。
对于接受MAC下EBUS检查的患者，与NC相比，NTM吸氧显著降低了低氧事件的发生率。对于其他在接受支气管镜检查时发生血氧饱和度降低风险增加的患者亚组，NTM可能也有价值。
