Department of Anesthesiology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd, Ratchathewi, Bangkok, 10400, Thailand.
BMC Anesthesiol. 2021 Sep 4;21(1):214. doi: 10.1186/s12871-021-01432-4.
The dead space washout and provision of some level of positive airway pressure by nasal high-flow (NHF) cannula could improve the efficiency of ventilation, oxygenation and maintenance of the upper airway in patients undergoing deep sedation. This study aimed to compare the incidences of events represented oxygenation and ventilation, i.e. desaturation and upper airway obstruction, and arterial blood gas (ABG) levels between using NHF cannula and conventional nasal cannula (NC2) during deep sedation of adult surgical patients.
In this prospective randomized single-blinded study, the patients who were 20-80 years old, ASA physical status of 1 to 3, scheduled for surgery under intravenous sedation (IVS) were included. The patients were randomly divided into two groups, i.e., NC2 or NHF groups. Propofol infusion was given to maintain deep sedation. The desaturation (SpO < 92%) and upper airway obstruction events (presence of snoring with paradoxical breathing) after application of NC2 or NHF were observed and collected. Other outcomes included interventions during IVS, such as jaw lifting or airway instrument insertion, mouth dryness, and post- ABG analyses were also collected and compared.
Thirty-six patients undergoing endovascular surgery were randomized into NC2 or NHF groups (18 in each group). No patients dropped out of the study. There were no significant differences in age, sex, ASA physical status, pre-sedation and pre-application of NC2 and NHF ABG analyses (PaO, SaO, pH, PaCO, and PaO/FiO). NHF group had significantly lower in the incidence of desaturation [5 (27.78%) vs 13 (72.22%), p = 0.008], upper airway obstruction [4 (22.22%) vs 13 (72.22%), p = 0.003], and airway maneuver [6 (33.33%) vs 13 (72.22%), p = 0.019] than NC2 group. There were no differences in the ABG analyses after oxygen supplementation and no significant differences in mouth dryness between groups.
The use of NHF cannula in patients undergoing endovascular surgery under deep sedation reduced desaturation events and required fewer airway interventions than NC2 with no difference in arterial blood gas analyses and mouth dryness.
通过鼻高流量（NHF）鼻塞冲洗死腔并提供一定水平的正压通气，可以提高接受深度镇静的患者的通气效率、氧合和上呼吸道的维持。本研究旨在比较使用 NHF 鼻塞和常规鼻导管（NC2）在成人外科手术患者深度镇静期间在代表氧合和通气的事件（即低氧血症和上呼吸道阻塞）发生率和动脉血气（ABG）水平方面的差异。
在这项前瞻性随机单盲研究中，纳入了年龄在 20-80 岁、ASA 身体状况 1-3 级、接受静脉镇静（IVS）下手术的患者。患者被随机分为 NC2 或 NHF 组。给予异丙酚输注以维持深度镇静。观察并收集应用 NC2 或 NHF 后出现的低氧血症（SpO<92%）和上呼吸道阻塞事件（存在打鼾伴矛盾呼吸）。其他结果包括 IVS 期间的干预措施，如抬下颌或插入气道器械、口干以及随后的 ABG 分析也被收集和比较。
36 例行血管内手术的患者被随机分为 NC2 或 NHF 组（每组 18 例）。没有患者退出研究。两组患者的年龄、性别、ASA 身体状况、镇静前和应用 NC2 及 NHF 前的 ABG 分析（PaO、SaO、pH、PaCO 和 PaO/FiO）无显著差异。NHF 组的低氧血症发生率[5（27.78%）比 13（72.22%），p=0.008]、上呼吸道阻塞发生率[4（22.22%）比 13（72.22%），p=0.003]和气道操作[6（33.33%）比 13（72.22%），p=0.019]均显著低于 NC2 组。氧补充后的 ABG 分析无差异，两组口干无差异。
在接受深度镇静的血管内手术患者中使用 NHF 鼻塞可降低低氧血症事件的发生，并减少气道干预的需要，与 NC2 相比，动脉血气分析和口干无差异。
