Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
South General Hospital, Stockholm, Sweden.
Anaesthesia. 2021 Sep;76(9):1176-1183. doi: 10.1111/anae.15426. Epub 2021 Feb 18.
Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during rapid sequence induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for rapid sequence induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where rapid sequence induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%, five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group, respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in the first breath after tracheal intubation or in the number of patients with signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for rapid sequence induction.
预吸氧使用高流量鼻氧可以降低在急诊手术中进行快速序列诱导时发生低氧血症的风险。以前的研究都是单中心的，而且往往在有限的环境中进行。这项随机、国际、多中心试验比较了高流量鼻氧与标准面罩预吸氧在白天和夜间所有时间的急诊手术中进行快速序列诱导的效果。共有来自瑞典六个中心和瑞士一个中心的 350 名成年患者入选并随机分配到使用高流量鼻氧或标准紧密贴合面罩进行 100%氧气预吸氧。主要结局是从预吸氧开始到气管插管后 1 分钟内发生氧饱和度<93%的患者人数。对进入研究的 350 名患者中的 349 名患者的数据进行了分析（高流量鼻氧组 174 名，面罩组 175 名）。在发生氧饱和度<93%的患者人数方面，没有发现两组之间的差异，高流量鼻氧组有 5 名（2.9%）患者，面罩组有 6 名（3.4%）患者（p=0.77）。在值班时间内，没有发现低氧血症的风险增加。在气管插管后第一次呼吸的呼气末二氧化碳水平或两组之间有反流迹象的患者数量方面，没有差异。这些结果证实，高流量鼻氧在快速序列诱导的预吸氧期间可以维持足够的氧合水平。
