Thiruvenkatarajan V, Dharmalingam A, Arenas G, Wahba M, Liu W-M, Zaw Y, Steiner R, Tran A, Currie J
Department of Anaesthesia, Queen Elizabeth Hospital, Woodville, SA, Australia.
Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
Anaesthesia. 2022 Jan;77(1):46-53. doi: 10.1111/anae.15527. Epub 2021 Jun 28.
Whether high-flow vs. low-flow nasal oxygen reduces hypoxaemia for sedation during endoscopic retrograde cholangiopancreatography is currently unknown. In this multicentre trial, 132 patients ASA physical status 3 or higher, BMI > 30 kg.m or with known or suspected obstructive sleep apnoea were randomly allocated to high-flow nasal oxygen up to 60 l.min at 100% F O or low-flow nasal oxygen at 4 l.min . The low-flow nasal oxygen group also received oxygen at 4 l.min through an oxygenating mouthguard, totalling 8 l.min . Primary outcome was hypoxaemia, defined as S O < 90% regardless of duration. Hypoxaemia occurred in 7.7% (5/65) of patients with high-flow and 9.1% (6/66) with low-flow nasal oxygen (percentage point difference -1.4%, 95%CI -10.9 to 8.0; p = 0.77). Between the groups, there were no significant differences in frequency of hypoxaemic episodes; lowest S O ; peak transcutaneous carbon dioxide; hypercarbia (transcutaneous carbon dioxide > 2.66 kPa from baseline); requirement of chin lift/jaw thrust; nasopharyngeal airway insertion; bag-mask ventilation; or tracheal intubation. Following adjustment for duration of the procedure, the primary outcome remained non-significant. In high-risk patients undergoing endoscopic retrograde cholangiopancreatography, oxygen therapy with high-flow nasal oxygen did not reduce the rate of hypoxaemia, hypercarbia or the need for airway interventions, compared with combined oral and nasal low-flow oxygen.
目前尚不清楚在经内镜逆行胰胆管造影术期间，高流量与低流量鼻导管给氧对减轻镇静期间的低氧血症是否有效。在这项多中心试验中，132例美国麻醉医师协会（ASA）身体状况分级为3级或更高、体重指数（BMI）>30 kg/m²或已知或疑似阻塞性睡眠呼吸暂停的患者被随机分配至高流量鼻导管给氧组（高达60 L/min，100%氧气）或低流量鼻导管给氧组（4 L/min）。低流量鼻导管给氧组还通过充氧口含器以4 L/min的速度吸氧，总吸氧流量为8 L/min。主要结局指标为低氧血症，定义为无论持续时间如何，血氧饱和度（SO）<90%。高流量鼻导管给氧组7.7%（5/65）的患者发生低氧血症，低流量鼻导管给氧组为9.1%（6/66）（百分点差异-1.4%，95%置信区间-10.9至8.0；p=0.77）。两组之间，低氧血症发作频率、最低SO、经皮二氧化碳峰值、高碳酸血症（经皮二氧化碳较基线升高>2.66 kPa）、抬颏/托下颌需求、鼻咽气道置入、面罩通气或气管插管方面均无显著差异。对手术持续时间进行校正后，主要结局指标仍无统计学意义。在接受经内镜逆行胰胆管造影术的高危患者中，与经口和鼻联合低流量给氧相比，高流量鼻导管给氧并未降低低氧血症、高碳酸血症的发生率或气道干预的需求。
