Division of Gastroenterology, Department of Internal Medicine, Inha University School of Medicine, 27 Inhang-ro, Jung-gu, Incheon, 400-711, Republic of Korea.
Division of Critical Care Medicine, Department of Hospital Medicine, Inha University School of Medicine, Incheon, Republic of Korea.
Sci Rep. 2021 Jan 11;11(1):350. doi: 10.1038/s41598-020-79798-7.
Hypoxemia can occur during endoscopic retrograde cholangiography (ERCP) and it is difficult to achieve adequate ventilation with the prone position. High-flow nasal oxygen (HFNO) has been recommended to be more effectively help ventilation than conventional low flow oxygen. The aim of this study was to evaluate the effect of HFNO during sedated ERCP and to identify predictors of desaturation during ERCP. The investigated variables were age, gender, American Society of Anesthesiologists classes (ASA), duration of exam, and sedative used for midazolam or/and propofol of 262 patients with sedated ERCP. The differences between categorical and continuous variables were analyzed using the Student's t test and the chi-square test. Desaturation (SpO ≤ 90%) occurred in 9(3.4%) patients among 262 patients during sedated ERCP. The variables found to predict desaturation were older age (p < 0.01), higher sedation dose for midazolam or propofol (p < 0.01), and use of midazolam (p < 0.01). Desaturation rate was lower during sedated ERCP with HFNO compared to the preliminary study with conventional low flow nasal oxygen. Patients with older age, higher sedation dose, or the use of midazolam might require close monitoring for desaturation and hypoventilation by nursing staff. The study shows the use of high-flow nasal oxygen reduces the incidence of desaturation during ERCP.
在逆行胰胆管造影（ERCP）期间可能会发生低氧血症，并且在俯卧位时难以实现充分通气。高流量鼻氧（HFNO）已被推荐比常规低流量氧更有效地帮助通气。本研究旨在评估镇静 ERCP 期间 HFNO 的效果，并确定 ERCP 期间发生低氧血症的预测因素。研究变量包括年龄、性别、美国麻醉医师协会（ASA）分级、检查持续时间以及咪达唑仑或/和丙泊酚镇静剂。使用学生 t 检验和卡方检验分析分类变量和连续变量之间的差异。在 262 例镇静 ERCP 患者中，有 9 例（3.4%）患者在镇静 ERCP 期间发生低氧血症（SpO≤90%）。预测低氧血症的变量为年龄较大（p<0.01）、咪达唑仑或丙泊酚的镇静剂量较高（p<0.01）和咪达唑仑的使用（p<0.01）。与初步使用常规低流量鼻氧的研究相比，HFNO 用于镇静 ERCP 时，低氧血症的发生率较低。年龄较大、镇静剂量较高或使用咪达唑仑的患者可能需要护理人员密切监测低氧血症和通气不足。该研究表明，使用高流量鼻氧可降低 ERCP 期间低氧血症的发生率。
