Ayuse Takao, Yamguchi Naoyuki, Hashiguchi Keiichi, Sanuki Takuro, Mishima Gaku, Kurata Shinji, Hosogaya Naoki, Nakashima Sawako, Pinkham Max, Tatkov Stanislav, Nakao Kazuhiko
Division of Clinical Physiology, Department of Translational Medical Sciences.
Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences.
Medicine (Baltimore). 2020 May;99(19):e20038. doi: 10.1097/MD.0000000000020038.
For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic submucosal dissection (ESD), intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous sedation, even at mild to moderate depth of anesthesia, there is always a risk of upper airway obstruction due to a relaxation of the upper airway muscles.With the advent of Nasal High Flow (NHF) devices that allow humidified high flow air through the nasal cavity, can be used as a respiratory management method in the context of anesthesia. AIRVO is commonly used for patients with obstructive sleep apnea and other respiratory disorders. This device uses a mild positive pressure load (several cmH2O) that improves carbon dioxide (CO2) washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia.This study aims to maintain upper airway patency by applying NHF with air (AIRVO) as a respiratory management method during intravenous anesthesia for patients undergoing an ESD. In addition, this study investigates whether the use of an NHF device in this context can prevent intraoperative hypercapnia and hypoxemia.
METHODS/DESIGN: This study design employed 2 groups of subjects. Both received intravenous anesthesia while undergoing an ESD, and 1 group also used a concurrent nasal cannula NHF device. Here we examine if the use of an NHF device during intravenous anesthesia can prevent hypoxemia and hypercapnia, which could translate to improved anesthesia management.Efficacy endpoints were assessed using a transcutaneous CO2 monitor. This device measured the changes in CO2 concentration during treatment. Transcutaneous CO2 (PtcCO2) concentrations of 60 mmHg or more (PaCO2 > 55 mmHg) were considered marked hypercapnia. PtcCO2 concentrations of 50 to 60 mmHg or more (equivalent to PaCO2 > 45 mmHg) were considered moderate hypercapnia.Furthermore, the incidence of hypoxemia with a transcutaneous oxygen saturation value of 90% or less, and whether the use of NHF was effective in preventing this adverse clinical event were evaluated.
The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ESD under anesthesia, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use of this device.
The study was registered the jRCTs 072190022.URL https://jrct.niph.go.jp/en-latest-detail/jRCTs072190022.
对于相对侵入性的上消化道内镜手术，如内镜黏膜下剥离术（ESD），通常采用静脉麻醉以减轻患者焦虑。然而，使用静脉镇静时，即使处于轻度至中度麻醉深度，由于上呼吸道肌肉松弛，始终存在上呼吸道梗阻的风险。随着鼻高流量（NHF）设备的出现，其可使加湿的高流量空气通过鼻腔，可作为麻醉情况下的一种呼吸管理方法。AIRVO常用于阻塞性睡眠呼吸暂停和其他呼吸系统疾病患者。该设备使用轻度正压负荷（几厘米水柱），可改善二氧化碳（CO2）清除并减少重复呼吸，从而改善呼吸功能，因此被广泛用于预防低氧血症和高碳酸血症。本研究旨在通过在接受ESD的患者静脉麻醉期间应用NHF通气（AIRVO）作为呼吸管理方法来维持上呼吸道通畅。此外，本研究还调查了在此情况下使用NHF设备是否可预防术中高碳酸血症和低氧血症。
方法/设计：本研究设计采用两组受试者。两组在接受ESD时均接受静脉麻醉，其中一组同时使用鼻导管NHF设备。在此，我们研究静脉麻醉期间使用NHF设备是否可预防低氧血症和高碳酸血症，这可能转化为改善麻醉管理。使用经皮CO2监测仪评估疗效终点。该设备测量治疗期间CO2浓度的变化。经皮CO2（PtcCO2）浓度≥60 mmHg（动脉血二氧化碳分压[PaCO2]＞55 mmHg）被视为明显高碳酸血症。PtcCO2浓度为50至60 mmHg或更高（相当于PaCO2＞45 mmHg）被视为中度高碳酸血症。此外，评估经皮血氧饱和度值≤90%的低氧血症发生率，以及使用NHF是否能有效预防这一不良临床事件。
本研究的目的是通过确定与未使用该设备的对照组相比，NHF设备组中高碳酸血症和低氧血症的发生率是否降低，来获取NHF作为麻醉下接受ESD患者潜在治疗设备效用的证据。
该研究已在jRCTs 072190022注册。网址：https://jrct.niph.go.jp/en-latest-detail/jRCTs072190022 。
