Wetsch Wolfgang A, Schroeder Daniel C, Finke Simon-Richard, Sander David, Ecker Hannes, Böttiger Bernd W, Herff Holger
University of Cologne, Faculty of Medicine; University Hospital of Cologne, Department of Anesthesiology and Postoperative Intensive Care Medicine, Cologne, Germany.
University of Cologne, Faculty of Medicine; University Hospital of Cologne, Department of Anesthesiology and Postoperative Intensive Care Medicine, Cologne; Department of Anesthesiology and Intensive Care, German Armed Forces Central Hospital of Koblenz, Koblenz, Germany.
Med Gas Res. 2022 Jan-Mar;12(1):28-31. doi: 10.4103/2045-9912.323536.
Oxygen application and apneic oxygenation may reduce the risk of hypoxemia due to apnea during awake fiberoptic intubation or failed endotracheal intubation. High flow devices are recommended, but their effect compared to moderate deep oropharyngeal oxygen application is unknown. Designed as an experimental manikin trial, we made a comparison between oxygen application via nasal prongs at 10 L/min (control group), applying oxygen via oropharyngeal oxygenation device (at 10 L/min), oxygen application via high flow nasal oxygen with 20 L/min and 90% oxygen (20 L/90% group), oxygen application via high flow nasal oxygen with 60 L/min and 45% oxygen (60 L/45% group), and oxygen application via sealed face mask with a special adapter to allow for fiberoptic entering of the airway. We preoxygenated the lung of a manikin and measured the decrease in oxygen level during the following 20 minutes for each way of oxygen application. Oxygen levels fell from 97 ± 1% at baseline to 75 ± 1% in control group, and to 86 ± 1% in oropharyngeal oxygenation device group. In the high flow nasal oxygen group, oxygen level dropped to 72 ± 1% in the 20 L/90% group and to 44 ± 1% in the 60 L/45% group. Oxygen level remained at 98 ± 0% in the face mask group. In conclusion, in this manikin simulation study of apneic oxygenation, oxygen insufflation using a sealed face mask kept oxygen levels in the test lung at 98% over 20 minutes, oral oxygenation device led to oxygen levels at 86%, whereas all other methods resulted in the decrease of oxygen levels below 75%.
吸氧和无呼吸氧合可降低清醒纤维支气管镜插管或气管插管失败期间因呼吸暂停导致的低氧血症风险。推荐使用高流量设备，但与适度深度口咽给氧相比，其效果尚不清楚。作为一项实验性人体模型试验，我们比较了以下几种给氧方式：通过鼻导管以10 L/分钟的流量给氧（对照组）、通过口咽给氧装置以10 L/分钟的流量给氧、通过高流量鼻导管以20 L/分钟和90%氧气的流量给氧（20 L/90%组）、通过高流量鼻导管以60 L/分钟和45%氧气的流量给氧（60 L/45%组）以及通过带有特殊适配器的密封面罩给氧，该适配器可使纤维支气管镜进入气道。我们对人体模型的肺部进行预充氧，并测量了每种给氧方式在接下来20分钟内的氧含量下降情况。对照组的氧含量从基线时的97±1%降至75±1%，口咽给氧装置组降至86±1%。在高流量鼻导管给氧组中，20 L/90%组的氧含量降至72±1%，60 L/45%组降至44±1%。面罩组的氧含量保持在98±0%。总之，在这项关于无呼吸氧合的人体模型模拟研究中，使用密封面罩吹入氧气可使测试肺的氧含量在20分钟内保持在98%，口咽给氧装置使氧含量达到86%，而所有其他方法均导致氧含量降至75%以下。
