Department of Anaesthesia and Intensive Care, Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France; Université de Paris, Paris, France; DHU PROTECT. Robert Debré Hospital, 48, boulevard Sérurier, 75019 Paris, France.
Department of Anaesthesia and Intensive Care, Jean Minjoz Hospital, 3, Bd Alexandre Flemming, 25000 Besançon, France.
Anaesth Crit Care Pain Med. 2021 Apr;40(2):100817. doi: 10.1016/j.accpm.2021.100817. Epub 2021 Mar 4.
The objective of this study was to measure the incidence of arterial oxygen desaturation during rapid sequence induction intubation in children following apnoeic oxygenation via transnasal humidified rapid-insufflation ventilatory exchange (THRIVE).
In this prospective observational study, arterial desaturation < 95% SaO before intubation was recorded following apnoeic RSI combining an intravenous hypnotic agent, suxamethonium and THRIVE (used during the apnoeic period). The incidence of desaturation was calculated in the whole cohort and according to patients' age (older or younger than 1 year).
Complete data were collected for 79 patients, 1 day to 15 years of age. Nine patients (11.4%) exhibited arterial desaturation before tracheal intubation and received active facemask ventilation. Patients exhibiting desaturation were more likely to be less than 1 year of age (9/9, (100%) versus 37/70, (52.9%); P = 0.005), to be reported as difficult intubations (5/9, (55.6%) versus 1/70, (1.4%), p < 0.001), and to have regurgitation at induction (2/9, (22.2%) versus 0/70, (0%), p = 0.01).
Results of the current study indicated that almost 91% of RSI can be performed without desaturation when THRIVE is used. A comparative controlled study is required to confirm these findings. Specific situations and conditions limiting the efficacy of THRIVE during RSI should also be investigated.
本研究的目的是测量经鼻湿化高流量快速通气交换（THRIVE）行无通气氧合后，儿童快速序贯诱导气管插管期间动脉血氧饱和度下降的发生率。
在这项前瞻性观察性研究中，记录了在阿片类药物诱导的 RSI 期间（使用无通气期），静脉注射催眠剂、琥珀胆碱和 THRIVE 联合使用后，插管前动脉血氧饱和度 < 95%SaO 的患者。计算了整个队列及根据患者年龄（大于或小于 1 岁）的发生率。
共纳入 79 例年龄 1 天至 15 岁的患者，完整数据收集完整。9 例（11.4%）患者在气管插管前出现动脉血氧饱和度下降，并接受了积极的面罩通气。出现血氧饱和度下降的患者更可能小于 1 岁（9/9，（100%）与 37/70，（52.9%）；P=0.005）、报告为困难插管（5/9，（55.6%）与 1/70，（1.4%），p<0.001），且诱导时存在反流（2/9，（22.2%）与 0/70，（0%），p=0.01）。
本研究结果表明，当 THRIVE 用于 RSI 时，近 91%的 RSI 可以在不发生血氧饱和度下降的情况下进行。需要进行对照研究来证实这些发现。还应调查限制 THRIVE 在 RSI 期间疗效的特定情况和条件。
