Department of Anesthesiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, PRC.
Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY.
J Cardiothorac Vasc Anesth. 2021 Oct;35(10):2913-2919. doi: 10.1053/j.jvca.2021.03.031. Epub 2021 Mar 27.
The study was conducted to compare the outcome of high-flow nasal cannula (HFNC) oxygen therapy with conventional oxygen therapy through a simple oxygen mask for pediatric patients with congenital heart disease during percutaneous intervention while under procedural sedation.
Prospective, randomized and controlled trial.
A Cantonese cardiac center in China.
Two hundred American Society of Anesthesiologists classification II pediatric patients were enrolled from April 25, 2018 to November 28, 2018.
Patients scheduled for percutaneous closure of a heart defect under deep sedation with propofol, midazolam and fentanyl by an anesthesiologist were randomized (1:1) to receive oxygen therapy through a simple oxygen mask or through the HFNC system.
The primary outcome was the lowest oxygen saturation (SpO). Secondary outcomes included the incidence of hypoxia (SpO < 90%), requirement for noninvasive respiratory support, change in the gastric antrum area and other adverse events. Blood gas analysis results also were compared. Oxygen therapy through the HFNC system improved the lowest SpO (99% [94%-100%]), as compared with the mask group (99% [72%-100%]), p < 0.001. Seven patients out of 99 (7.1%) in the mask group had hypoxia or required bag-mask ventilation, whereas no such patient was reported in the HFNC group, p < 0.001. There were no differences between the groups in terms of gastric distention, procedure length, total propofol dose, atropine use or other complications.
When compared with simple mask oxygenation, HFNC could reduce the incidence of desaturation, the need for airway assisted ventilation and risk of carbon dioxide retention without causing hemodynamic instability or gastric distention. It is effective for pediatric patients with non-cyanotic congenital heart disease who require procedural sedation.
本研究旨在比较经皮介入治疗期间，在程序镇静下，使用高流量鼻导管（HFNC）吸氧与传统的简单面罩吸氧治疗先天性心脏病患儿的效果。
前瞻性、随机对照试验。
中国一家广东地区心脏中心。
2018 年 4 月 25 日至 2018 年 11 月 28 日期间，纳入 200 名美国麻醉医师协会（ASA）分级 II 级的儿科患者。
患者在麻醉医师深镇静下接受丙泊酚、咪达唑仑和芬太尼行介入治疗，采用随机（1:1）方法接受简单面罩或 HFNC 系统吸氧。
主要结局为最低血氧饱和度（SpO ）。次要结局包括缺氧发生率（SpO < 90%）、需要无创呼吸支持、胃窦面积变化和其他不良事件。比较血气分析结果。与面罩组（99%[72%-100%]）相比，HFNC 组的最低 SpO （99%[94%-100%]）更高（p < 0.001）。面罩组有 7 例（7.1%）患者发生缺氧或需要球囊面罩通气，而 HFNC 组无此类患者（p < 0.001）。两组在胃扩张、操作时间、总丙泊酚剂量、阿托品使用或其他并发症方面无差异。
与简单面罩吸氧相比，HFNC 可降低饱和度下降、需要气道辅助通气和二氧化碳潴留的风险，而不会引起血流动力学不稳定或胃扩张。对于需要程序镇静的非发绀型先天性心脏病患儿，HFNC 是一种有效的治疗方法。
