Division of Emergency Medicine, Department of Emergency and Critical Care, Taipei Medical University-Shuang Ho Hospital, 291, Zhongzheng Road, Zhonghe District, New Taipei City, 23561, Taiwan.
Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
BMC Anesthesiol. 2022 Sep 30;22(1):306. doi: 10.1186/s12871-022-01842-y.
Preoxygenation is crucial for providing sufficient oxygen reservoir to a patient before intubation and enables the extension of the period between breathing termination and critical desaturation (safe apnoea time). Conventionally, face mask ventilation is used for preoxygenation. Non-invasive ventilation is a new preoxygenation method. The study objective was to compare the outcomes of non-invasive ventilation and face mask ventilation for preoxygenation.
PubMed, Embase, Cochrane Library, and the ClinicalTrials.gov registry were searched for eligible studies published from database inception to September 2021. Individual effect sizes were standardized, and a meta-analysis was conducted using random effects models to calculate the pooled effect size. Inclusion criteria were randomised controlled trials of comparing the outcomes of non-invasive ventilation or face mask ventilation for preoxygenation in patients scheduled for surgeries. The primary outcome was safe apnea time, and the secondary outcomes were post-operative complications, number of patients who achieved the expired O fraction (FeO) after 3 min of preoxygenation, minimal SpO during tracheal intubation, partial pressure of oxygen in the arterial blood (PaO) and partial pressure of carbon dioxide (PaCO) after preoxygenation, and PaO and PaCO after tracheal intubation.
13 trials were eligible for inclusion in this study. Significant differences were observed in safe apnoea time, number of patients who achieved FeO 90% after preoxygenation for 3 min, and PaO and PaCO after preoxygenation and tracheal intubation. Only in the non-obese subgroup, no significant difference was observed in safe apnoea time (mean difference: 125.38, 95% confidence interval: - 12.26 to 263.03).
Non-invasive ventilation appeared to be more effective than conventional methods for preoxygenation. We recommend non-invasive ventilation based on our results.
预充氧对于在插管前为患者提供充足的氧气储备至关重要，并且可以延长呼吸停止和严重低氧（安全无通气时间）之间的时间。传统上，使用面罩通气进行预充氧。非侵入性通气是一种新的预充氧方法。本研究的目的是比较非侵入性通气和面罩通气用于预充氧的效果。
检索 PubMed、Embase、Cochrane 图书馆和 ClinicalTrials.gov 注册中心，检索自数据库成立至 2021 年 9 月期间发表的合格研究。对个体效应量进行标准化，并使用随机效应模型进行荟萃分析，以计算汇总效应量。纳入标准为比较非侵入性通气或面罩通气用于计划手术患者预充氧的随机对照试验。主要结局为安全无通气时间，次要结局为术后并发症、预充氧 3 分钟后达到呼出氧分数（FeO）的患者人数、气管插管期间最小 SpO2、动脉血氧分压（PaO）和二氧化碳分压（PaCO）在预充氧后，以及气管插管后 PaO 和 PaCO。
共有 13 项试验符合纳入本研究的标准。在安全无通气时间、预充氧 3 分钟后达到 FeO90%的患者人数以及预充氧和气管插管后的 PaO 和 PaCO 方面，观察到显著差异。只有在非肥胖亚组中，安全无通气时间无显著差异（平均差异：125.38，95%置信区间：-12.26 至 263.03）。
非侵入性通气似乎比传统方法更有效地用于预充氧。根据我们的结果，我们推荐使用非侵入性通气。
