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图像引导热消融手术中高频喷射通气的安全性

Safety of High-Frequency Jet Ventilation During Image-Guided Thermal Ablation Procedures.

作者信息

Trochu Théophane, Desfriches-Doria Nathalie, Grillot Nicolas, Feuillet Fanny, Lair David, Liberge Renan, Douane Frédéric, Dumont Romain, David Arthur

机构信息

Department of Radiology, Nantes University Hospital, 1, place Alexis Ricordeau, 44093, Nantes, France.

Pôle d'Anesthésie Réanimation Chirurgicale, CHU Nantes, Université de Nantes, Hôtel-Dieu, 1, place Alexis Ricordeau, 44093, Nantes, France.

出版信息

Cardiovasc Intervent Radiol. 2023 Mar;46(3):360-368. doi: 10.1007/s00270-023-03358-5. Epub 2023 Jan 19.

Abstract

RATIONALE AND OBJECTIVE

Percutaneous thermal ablative technique is a common radiological procedure for malignant lesions treatment. Controlled assisted ventilation during general anesthesia is the usual mode of ventilation, but high-frequency jet ventilation (HFJV) can be a helpful alternative for the operator. The objective was to evaluate the safety of HFJV during thermal ablation procedures.

MATERIALS AND METHODS

This monocentric prospective analysis included adult patients undergoing percutaneous thermal ablation procedures for abdominal tumor performed under HFJV. Procedures with a transpulmonary path were excluded. The primary outcome was the incidence of respiratory complications. Secondary outcomes included gas exchange modifications (hypercapnia, hypoxemia, pulmonary atelectasis) and the incidence of barotrauma.

RESULTS

Sixty patients were included during the study period. The mean duration time was 88 min. All procedures went according to the protocol and there was no respiratory complication. There was no barotrauma event. Three patients had an exhaled capnia above 45 mmHg at the end of the procedure which normalized within 10 min of conventional ventilation.

CONCLUSION

HFJV during thermal ablation procedures is safe regarding gas exchange and barotrauma. This technique could be an interesting alternative to conventional ventilation during image-guided thermal ablation procedures. Clinical Trials database This study was registered in Clinical Trials database (NCT04209608).

摘要

原理与目的

经皮热消融技术是治疗恶性病变的一种常见放射学方法。全身麻醉期间控制辅助通气是常用的通气模式,但高频喷射通气(HFJV)对操作者而言可能是一种有用的替代方法。目的是评估热消融手术期间HFJV的安全性。

材料与方法

这项单中心前瞻性分析纳入了在HFJV下接受腹部肿瘤经皮热消融手术的成年患者。排除经肺路径的手术。主要结局是呼吸并发症的发生率。次要结局包括气体交换改变(高碳酸血症、低氧血症、肺不张)和气压伤的发生率。

结果

研究期间纳入了60例患者。平均持续时间为88分钟。所有手术均按照方案进行,未发生呼吸并发症。未发生气压伤事件。3例患者在手术结束时呼出二氧化碳分压高于45 mmHg,在常规通气10分钟内恢复正常。

结论

热消融手术期间HFJV在气体交换和气压伤方面是安全的。该技术可能是影像引导热消融手术期间传统通气的一种有趣替代方法。临床试验数据库 本研究已在临床试验数据库注册(NCT04209608)。

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