二氧化碳描记法和脉搏血氧饱和度测定法可改善冠状动脉旁路移植术患者的快速拔管：一项随机临床试验
Capnography and Pulse Oximetry Improve Fast Track Extubation in Patients Undergoing Coronary Artery Bypass Graft Surgery: A Randomized Clinical Trial.
作者信息
Moradian Seyed Tayeb, Beitollahi Fatemah, Ghiasi Mohammad Saeid, Vahedian-Azimi Amir
机构信息
Atherosclerosis Research Center, Nursing Faculty, Baqiyatallah university of Medical Sciences, Tehran, Iran.
Atherosclerosis Research Center, Medicine Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
出版信息
Front Surg. 2022 May 11;9:826761. doi: 10.3389/fsurg.2022.826761. eCollection 2022.
BACKGROUND
Use of capnography as a non-invasive method during the weaning process for fast track extubation (FTE) is controversial. We conducted the present study to determine whether pulse oximetry and capnography could be utilized as alternatives to arterial blood gas (ABG) measurements in patients under mechanical ventilation (MV) following coronary artery bypass graft (CABG) surgery.
METHODS
In this randomized clinical trial, 70 patients, who were candidates for CABG surgery, were randomly assigned into two equal groups ( = 35), intervention and control group. In the intervention group, the ventilator management and weaning from MV was done using Etco2 from capnography and SpO2 from pulse oximetry. Meanwhile, in the control group, weaning was done based on ABG analysis. The length of intensive care unit (ICU) stay, time to extubation, number of manual ventilators setting changes, and alarms were compared between the groups.
RESULTS
The end-tidal carbon dioxide (ETCO2) levels in the intervention group were completely similar to the partial pressure of carbon dioxide (PaCo2) in the control group (39.5 ± 3.1 vs. 39.4 ± 4.32, > 0.05). The mean extubation times were significantly shorter in the intervention group compared to those in the control patients (212.2 ± 80.6 vs. 342.7 ± 110.7, < 0.001). Moreover, the number of changes in the manual ventilator setting and the number of alarms were significantly lower in the intervention group. However, the differences in the length of stay in ICU between the two groups were not significant ( = 0.219).
CONCLUSION
Our results suggests that capnography can be used as an alternative to ABG. Furthermore, it is a safe and valuable monitor that could be a good alternative for ABG in this population. Further studies with larger sample sizes and on different disease states and populations are required to assess the accuracy of our findings.
CLINICAL TRIAL REGISTRATION
Current Controlled Trials, IRCT, IRCT201701016778N6, Registered 3 March 2017, https://www.irct.ir/trial/7192.
背景
在快速康复拔管（FTE）的撤机过程中，使用二氧化碳描记法作为一种非侵入性方法存在争议。我们开展了本研究，以确定在冠状动脉旁路移植术（CABG）后接受机械通气（MV）的患者中，脉搏血氧饱和度测定法和二氧化碳描记法是否可作为动脉血气（ABG）测量的替代方法。
方法
在这项随机临床试验中，70例拟行CABG手术的患者被随机分为两组，每组35例，即干预组和对照组。干预组使用二氧化碳描记法的呼气末二氧化碳（Etco2）和脉搏血氧饱和度测定法的SpO2进行呼吸机管理和撤机。同时，对照组根据ABG分析进行撤机。比较两组重症监护病房（ICU）住院时间、拔管时间、手动呼吸机设置更改次数和警报次数。
结果
干预组的呼气末二氧化碳（ETCO2）水平与对照组的二氧化碳分压（PaCo2）完全相似（39.5±3.1 vs. 39.4±4.32，P>0.05）。与对照组患者相比，干预组的平均拔管时间显著缩短（212.2±80.6 vs. 342.7±110.7，P<0.001）。此外，干预组手动呼吸机设置的更改次数和警报次数显著更低。然而，两组之间的ICU住院时间差异不显著（P=0.219）。
结论
我们的结果表明，二氧化碳描记法可作为ABG的替代方法。此外，它是一种安全且有价值的监测手段，在该人群中可能是ABG的良好替代方法。需要进行更大样本量以及针对不同疾病状态和人群的进一步研究，以评估我们研究结果的准确性。
临床试验注册
当前受控试验，伊朗临床试验注册中心，IRCT201701016778N6，于2017年3月3日注册，https://www.irct.ir/trial/7192 。
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