改良高流量鼻导管氧疗与常规氧疗在支气管镜检查患者中的比较：一项随机临床试验。
Modified high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy: a randomized clinical trial.
机构信息
Department of Respiratory and Critical Care Medicine, Beijing Chao-Yang Hospital, Beijing Institute of Respiratory Medicine, Beijing Key Laboratory of Respiratory and Pulmonary Circulation Disorders, Beijing Engineering Research Centre for Diagnosis and Treatment of Respiratory and Critical Care Medicine (Beijing Chao-Yang Hospital), Capital Medical University, No. 8 Gongtinan Road, Chaoyang, Beijing, 100020, China.
出版信息
BMC Pulm Med. 2021 Nov 14;21(1):367. doi: 10.1186/s12890-021-01744-8.
BACKGROUND
Hypoxemia frequently occurs during bronchoscopy. High-flow nasal cannula (HFNC) oxygen therapy may be a feasible alternative to prevent the deterioration of gas exchange during bronchoscopy. With the convenience of clinical use in mind, we modified an HFNC using a single cannula. This clinical trial was designed to test the hypothesis that a modified HFNC would decrease the proportion of patients with a single moment of peripheral arterial oxygen saturation (SpO) < 90% during bronchoscopy.
METHODS
In this single-center, prospective randomized controlled trial, hospitalized patients in the respiratory department in need of diagnostic bronchoscopy were randomly assigned to a modified HFNC oxygen therapy group or a conventional oxygen therapy (COT) group. The primary outcome was the proportion of patients with a single moment of SpO < 90% during bronchoscopy.
RESULTS
Eight hundred and twelve patients were randomized to the modified HFNC (n = 406) or COT (n = 406) group. Twenty-four patients were unable to cooperate or comply with bronchoscopy. Thus, 788 patients were included in the analysis. The proportion of patients with a single moment of SpO < 90% during bronchoscopy in the modified HFNC group was significantly lower than that in the COT group (12.5% vs. 28.8%, p < 0.001). There were no significant differences in the fraction of inspired oxygen between the two groups. The lowest SpO during bronchoscopy and 5 min after bronchoscopy in the modified HFNC group was significantly higher than that in the COT group. Multivariate analysis showed that a baseline forced vital capacity (FVC) < 2.7 L (OR, 0.276; 95% CI, 0.083-0.919, p = 0.036) and a volume of fluid instilled > 60 ml (OR, 1.034; 95% CI, 1.002-1.067, p = 0.036) were independent risk factors for hypoxemia during bronchoscopy in the modified HFNC group.
CONCLUSIONS
A modified HFNC could decrease the proportion of patients with a single moment of SpO < 90% during bronchoscopy. A lower baseline FVC and large-volume bronchoalveolar lavage may predict desaturation during bronchoscopy when using a modified HFNC. Trial registration ClinicalTrials. Gov: NCT02606188. Registered 17 November 2015.
背景
支气管镜检查过程中常发生低氧血症。高流量鼻导管（HFNC）氧疗可能是一种可行的替代方法，可防止支气管镜检查过程中气体交换恶化。为了临床应用的方便，我们对 HFNC 进行了改进，使用了单根导管。本临床试验旨在检验以下假设：改良型 HFNC 可降低支气管镜检查过程中患者单次外周动脉血氧饱和度（SpO）<90%的比例。
方法
这是一项单中心前瞻性随机对照试验，呼吸科住院患者需要行诊断性支气管镜检查，随机分为改良 HFNC 氧疗组或常规氧疗（COT）组。主要结局为支气管镜检查过程中患者单次 SpO<90%的比例。
结果
812 例患者被随机分配至改良 HFNC 组（n=406）或 COT 组（n=406）。24 例患者因无法配合或遵行支气管镜检查而被排除。因此，788 例患者纳入分析。改良 HFNC 组支气管镜检查过程中患者单次 SpO<90%的比例显著低于 COT 组（12.5%比 28.8%，p<0.001）。两组间吸入氧分数无显著差异。改良 HFNC 组支气管镜检查及检查后 5min 时最低 SpO 显著高于 COT 组。多变量分析显示，基线用力肺活量（FVC）<2.7L（OR，0.276；95%CI，0.083-0.919，p=0.036）和灌洗液量>60ml（OR，1.034；95%CI，1.002-1.067，p=0.036）是改良 HFNC 组患者支气管镜检查过程中发生低氧血症的独立危险因素。
结论
改良 HFNC 可降低支气管镜检查过程中患者单次 SpO<90%的比例。较低的基线 FVC 和大容量支气管肺泡灌洗可能预示着使用改良 HFNC 时会发生支气管镜检查过程中的血氧饱和度下降。
试验注册
ClinicalTrials.gov：NCT02606188。注册于 2015 年 11 月 17 日。
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