在心脏植入式电子设备程序镇静期间使用高流量鼻氧：一项随机对照试验。

High flow nasal oxygen during procedural sedation for cardiac implantable electronic device procedures: A randomised controlled trial.

机构信息

From the Peter Munk Cardiac Centre, University Health Network (AC, PC, KC), Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada (AC, NK), School of Nursing, Queensland University of Technology (QUT), Brisbane, Queensland, Australia (AC), Department of Anesthesia and Pain Management, UHN (ALF, PL, MP), Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada (MP).

出版信息

Eur J Anaesthesiol. 2021 Aug 1;38(8):839-849. doi: 10.1097/EJA.0000000000001458.

DOI:10.1097/EJA.0000000000001458

PMID:33492872

Abstract

BACKGROUND

High flow nasal oxygen may better support the vulnerable respiratory state of patients during procedural sedation.

OBJECTIVE

The objective of this study was to investigate the effects of high flow nasal oxygen in comparison to facemask oxygen on ventilation during cardiac implantable electronic device procedures performed with procedural sedation.

DESIGN

A randomised controlled trial.

SETTING

The study was conducted at one academic hospital in Canada.

PARTICIPANTS

Adults undergoing elective cardiac implantable electronic device procedures with sedation administered by an anaesthesia assistant, supervised by an anaesthesiologist from August 2019 to March 2020.

INTERVENTIONS

Participants were randomised 1 : 1 to facemask (≥ 8 l · min-1) or high flow nasal oxygen (50 l · min-1 and a 50 : 50 oxygen to air ratio).

MAIN OUTCOME MEASURES

The primary outcome was peak transcutaneous carbon dioxide. Outcomes were analysed using Bayesian statistics.

RESULTS

The 129 participants who were randomised and received sedation were included. The difference in peak transcutaneous carbon dioxide was 0.0 kPa (95% CI -0.17 to 0.18). Minor adverse sedation events were 6.4 times more likely to occur in the high flow nasal oxygen group. This estimate is imprecise (95% CI 1.34 to 42.99). The odds ratio for oxygen desaturation for the high flow nasal oxygen group compared with the facemask group was 1.2 (95% CI 0.37 to 3.75). The difference in satisfaction with sedation scores between groups was 0.0 (95% CI -0.33 to 0.23).

CONCLUSIONS

Ventilation, as measured by TcCO2, is highly unlikely to differ by a clinically important amount between high flow nasal oxygen at 50 l min-1 or facemask oxygen at 8 l min-1. Further research with a larger sample size would be required to determine the optimal oxygen:air ratio when using high flow nasal oxygen during cardiac implantable electronic device procedures performed with sedation.

TRIAL REGISTRATION NUMBER

NCT03858257.

摘要

背景

高流量鼻氧可能在程序镇静期间更好地支持患者脆弱的呼吸状态。

目的

本研究旨在调查高流量鼻氧与面罩氧在接受镇静的心脏植入式电子设备程序期间通气的影响。

设计

随机对照试验。

设置

该研究在加拿大的一家学术医院进行。

参与者

2019 年 8 月至 2020 年 3 月期间接受镇静的择期心脏植入式电子设备程序的成年人，由麻醉助理给药，由麻醉师监督。

干预措施

参与者被随机分配 1：1 接受面罩（≥8 l/min）或高流量鼻氧（50 l/min 和 50:50 氧气与空气比例）。

主要结局测量

主要结局是经皮二氧化碳峰值。使用贝叶斯统计分析结果。

结果

纳入了 129 名被随机分配并接受镇静的参与者。经皮二氧化碳峰值的差异为 0.0 kPa（95%CI-0.17 至 0.18）。高流量鼻氧组发生轻度不良镇静事件的可能性高 6.4 倍。这一估计不太准确（95%CI 1.34 至 42.99）。与面罩组相比，高流量鼻氧组的氧饱和度下降的比值比为 1.2（95%CI 0.37 至 3.75）。与面罩组相比，高流量鼻氧组的镇静满意度评分差异为 0.0（95%CI-0.33 至 0.23）。