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持续气道正压通气减少儿童呼吸暂停发作后早期外周氧饱和度降低的风险:一项双盲随机对照试验。

Continuous positive airway pressure to reduce the risk of early peripheral oxygen desaturation after onset of apnoea in children: A double-blind randomised controlled trial.

机构信息

Support and Therapeutic Diagnosis Division, Anesthesiology and Post-Anesthetic Care Unit, Federal University of Pernambuco's Teaching Hospital, Recife, Pernambuco, Brazil.

Department of Post-graduation, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil.

出版信息

PLoS One. 2021 Oct 1;16(10):e0256950. doi: 10.1371/journal.pone.0256950. eCollection 2021.

Abstract

Continuous positive airway pressure (CPAP) during anaesthesia induction improves oxygen saturation (SpO2) outcomes in adults subjected to airway manipulation, and could similarly support oxygenation in children. We evaluated whether CPAP ventilation and passive CPAP oxygenation in children would defer a SpO2 decrease to 95% after apnoea onset compared to the regular technique in which no positive airway pressure is applied. In this double-blind, parallel, randomised controlled clinical trial, 68 children aged 2-6 years with ASA I-II who underwent surgery under general anaesthesia were divided into CPAP and control groups (n = 34 in each group). The intervention was CPAP ventilation and passive CPAP oxygenation using an anaesthesia workstation. The primary outcome was the elapsed time until SpO2 decreased to 95% during a follow-up period of 300 s from apnoea onset (T1). We also recorded the time required to regain baseline levels from an SpO2 of 95% aided by positive pressure ventilation (T2). The median T1 was 278 s (95% confidence interval [CI]: 188-368) in the CPAP group and 124 s (95% CI: 92-157) in the control group (median difference: 154 s; 95% CI: 58-249; p = 0.002). There were 17 (50%) and 32 (94.1%) primary events in the CPAP and control groups, respectively. The hazard ratio was 0.26 (95% CI: 0.14-0.48; p<0.001). The median for T2 was 21 s (95% CI: 13-29) and 29 s (95% CI: 22-36) in the CPAP and control groups, respectively (median difference: 8 s; 95% CI: -3 to 19; p = 0.142). SpO2 was significantly higher in the CPAP group than in the control group throughout the consecutive measures between 60 and 210 s (with p ranging from 0.047 to <0.001). Thus, in the age groups examined, CPAP ventilation and passive CPAP oxygenation deferred SpO2 decrease after apnoea onset compared to the regular technique with no positive airway pressure.

摘要

持续气道正压通气(CPAP)在麻醉诱导期间可改善接受气道操作的成年人的血氧饱和度(SpO2)结局,并且在儿童中也可以支持氧合。我们评估了在没有应用正压通气的常规技术中,CPAP 通气和被动 CPAP 氧合是否可以延迟儿童在呼吸暂停发作后 SpO2 降至 95%的时间。在这项双盲、平行、随机对照临床试验中,纳入了 68 名年龄在 2-6 岁、ASA I-II 级、在全身麻醉下接受手术的儿童,将其分为 CPAP 组和对照组(每组 34 名)。干预措施为使用麻醉工作站进行 CPAP 通气和被动 CPAP 氧合。主要结局是从呼吸暂停发作开始后的 300 秒内 SpO2 下降到 95%的时间(T1)。我们还记录了在 SpO2 从 95%借助正压通气恢复到基线水平所需的时间(T2)。CPAP 组的 T1 中位数为 278 秒(95%可信区间:188-368),对照组为 124 秒(95%可信区间:92-157)(中位数差异:154 秒;95%可信区间:58-249;p=0.002)。CPAP 组和对照组分别有 17 例(50%)和 32 例(94.1%)发生主要事件。风险比为 0.26(95%可信区间:0.14-0.48;p<0.001)。CPAP 组和对照组的 T2 中位数分别为 21 秒(95%可信区间:13-29)和 29 秒(95%可信区间:22-36)(中位数差异:8 秒;95%可信区间:-3 至 19;p=0.142)。在 60 至 210 秒之间的连续测量中,CPAP 组的 SpO2 始终高于对照组(p 值范围从 0.047 至<0.001)。因此,在研究的年龄组中,CPAP 通气和被动 CPAP 氧合延迟了呼吸暂停发作后 SpO2 的下降,与没有应用正压通气的常规技术相比。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0a6b/8486132/4539e03a8a6f/pone.0256950.g001.jpg

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