Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan.
Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan.
Sci Rep. 2022 Apr 19;12(1):6448. doi: 10.1038/s41598-022-10396-5.
This meta-analysis aimed at investigating the efficacy of high-flow nasal oxygenation (HFNO) against hypoxemia in patients with obesity compared with conventional oxygenation therapy and non-invasive ventilation. Databases were searched from inception to August 2021. Studies involving peri- or post-procedural use of HFNO were included. The primary outcome was risk of hypoxemia, while the secondary outcomes included status of oxygenation and carbon dioxide elimination. Ten randomized controlled trials (RCTs) were included. We found that HFNO prolonged the safe apnea time at induction compared to control group [mean difference (MD) = 73.88 s, p = 0.0004; 2 RCTs] with no difference in risk of peri-procedural hypoxemia [relative risk (RR) = 0.91, p = 0.64; 4 RCTs], minimum SpO2 (MD = 0.09%, p = 0.95; 4 RCTs), PaO2 (MD = - 8.13 mmHg, p = 0.86; 3 RCTs), PaCO2 (MD = - 6.71%, p = 0.2; 2 RCTs), EtCO2 (MD = - 0.28 mmHg, p = 0.8; 4 RCTs) between the two groups. HFNO also did not improve postprocedural PaO2/FiO2 ratio (MD = 41.76, p = 0.58; 2 RCTs) and PaCO2 (MD = - 2.68 mmHg, p = 0.07; 2 RCTs). This meta-analysis demonstrated that the use of HFNO may be associated with a longer safe apnea time without beneficial impact on the risk of hypoxemia, oxygenation, and CO2 elimination in patients with obesity. The limited number of trials warranted further large-scale studies to support our findings.
本荟萃分析旨在研究高流量鼻氧疗（HFNO）与常规氧疗和无创通气相比，在肥胖患者低氧血症中的疗效。检索了从创建到 2021 年 8 月的数据库。纳入了围手术期或术后使用 HFNO 的研究。主要结局是低氧血症的风险，次要结局包括氧合状态和二氧化碳清除。共纳入 10 项随机对照试验（RCT）。我们发现，与对照组相比，HFNO 延长了诱导时的安全无通气时间[平均差值（MD）=73.88 s，p=0.0004；2 项 RCT]，但围手术期低氧血症的风险无差异[相对风险（RR）=0.91，p=0.64；4 项 RCT]，最低 SpO2（MD=0.09%，p=0.95；4 项 RCT），PaO2（MD=-8.13mmHg，p=0.86；3 项 RCT），PaCO2（MD=-6.71%，p=0.2；2 项 RCT），EtCO2（MD=-0.28mmHg，p=0.8；4 项 RCT）。HFNO 也不能改善术后 PaO2/FiO2 比值（MD=41.76，p=0.58；2 项 RCT）和 PaCO2（MD=-2.68mmHg，p=0.07；2 项 RCT）。本荟萃分析表明，HFNO 的使用可能与更长的安全无通气时间相关，但对肥胖患者的低氧血症、氧合和二氧化碳清除风险没有有益影响。试验数量有限，需要进一步的大规模研究来支持我们的发现。
