在儿科急诊中，快速序列插管前的吸氧分数作为预充氧的衡量标准。

Fraction of Expired Oxygen as a Measure of Preoxygenation Prior to Rapid Sequence Intubation in the Pediatric Emergency Department.

机构信息

Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio; University of Cincinnati, College of Medicine, Cincinnati, Ohio.

University of Cincinnati, College of Medicine, Cincinnati, Ohio.

出版信息

J Emerg Med. 2022 Jul;63(1):62-71. doi: 10.1016/j.jemermed.2022.04.023. Epub 2022 Aug 4.

DOI:10.1016/j.jemermed.2022.04.023

PMID:35933262

Abstract

BACKGROUND

Pulse oximetry (SpO) is a flawed measure of adequacy of preoxygenation prior to intubation. The fraction of expired oxygen (FeO) is a promising but understudied alternative.

OBJECTIVE

To investigate FeO as a measure of preoxygenation prior to intubation in a pediatric emergency department.

METHODS

We conducted a prospective, observational study of patients 18 and younger. We collected data using video review, and FeO was measured via inline sampling. The main outcomes were FeO and SpO at the start of preoxygenation, end of preoxygenation/start of intubation attempt, and the end of intubation attempt. We compared FeO and SpO at the end of preoxygenation for patients with and without oxyhemoglobin desaturation.

RESULTS

We enrolled 85 of 88 eligible patients during the 14-month study period. FeO data were available at the start of preoxygenation for 53 of 85 patients (62%), and for the end of preoxygenation for 59 of 85 patients (69%). Median FeO at the start and end of preoxygenation was 90% (interquartile range [IQR] 88, 92) and 90% (IQR 88, 92). Median SpO at the start and end of preoxygenation was 100% (IQR 100, 100). There were 11 episodes of desaturation, with median FeO at the start of intubation attempt of 89.5 (IQR 54.5, 91.5) and median SpO of 100 (IQR 99, 100). Patients who did not have a desaturation event had a median FeO of 90.0 (IQR 88.0, 92.0).

CONCLUSIONS

Measuring FeO during rapid sequence intubation is challenging with feasibility limitations, but may be a more discriminatory metric of adequate preoxygenation.

摘要

背景

脉搏血氧饱和度（SpO）是一种在插管前评估预充氧充足程度的有缺陷的方法。呼出氧分数（FeO）是一种有前途但研究不足的替代方法。

目的

在儿科急诊室研究 FeO 作为插管前预充氧的衡量指标。

方法

我们对 18 岁及以下的患者进行了一项前瞻性、观察性研究。我们通过视频回顾收集数据，并通过在线采样测量 FeO。主要结局是预充氧开始时、预充氧结束/插管尝试开始时和插管尝试结束时的 FeO 和 SpO。我们比较了预充氧结束时伴有和不伴有氧合血红蛋白去饱和的患者的 FeO 和 SpO。

结果

在 14 个月的研究期间，我们共纳入了 88 名符合条件的患者中的 85 名。53 名（62%）患者的预充氧开始时和 59 名（69%）患者的预充氧结束时可获得 FeO 数据。预充氧开始时和结束时的中位 FeO 分别为 90%（四分位距 [IQR] 88，92）和 90%（IQR 88，92）。预充氧开始时和结束时的中位 SpO 分别为 100%（IQR 100，100）。有 11 例患者出现血氧饱和度下降，插管尝试开始时的中位 FeO 为 89.5（IQR 54.5，91.5），中位 SpO 为 100（IQR 99，100）。未发生血氧饱和度下降事件的患者中位 FeO 为 90.0（IQR 88.0，92.0）。