Johnson Mark Z, Devine Gary, Marshall Rebecca
School of Medicine, University College Dublin, Dublin, IRL.
Anesthesia, Fiona Stanley Hospital, Perth, AUS.
Cureus. 2023 Jan 13;15(1):e33738. doi: 10.7759/cureus.33738. eCollection 2023 Jan.
Supplemental oxygen is routinely administered to patients prior to and during induction of general anesthesia and sedation. This increases the fraction of oxygen in the lungs, increases oxygen delivery, and increases the time to oxygen desaturation. Proprietary Transnasal Humidified Rapid-Insufflation Ventilatory Exchange (THRIVE) systems, which deliver warmed and humidified oxygen, have been extensively researched in the perioperative and critical care setting and have been shown to significantly prolong time to desaturation and as a means of ventilatory support. The use of traditional nasal oxygen cannula used at maximum flow rates is currently used in short bursts as it is poorly tolerated. There is however a dearth of data examining the use of this technique. We hypothesized that traditional nasal oxygen cannulae used at maximum flow rates can deliver oxygen as effectively as THRIVE in this setting.
We designed a crossover volunteer feasibility study. The participants were 10 healthy anesthetists. We compared the two methods of oxygen delivery by measuring transcutaneous oxygen measurement and pharyngeal oxygen concentration. Comfort and noise levels were recorded. The aforementioned parameters were compared between the two groups.
We observed that a standard oxygen cannula used at high flows delivers comparable oxygen delivery and tissue oxygenation performance to proprietary THRIVE systems. However, they are less comfortable and make more noise.
To the authors' knowledge this study is the first to study the oxygen delivery of traditional nasal oxygen cannula used at maximum flow rates and make comparisons to the well-studied THRIVE technique. While similar transcutaneous partial pressure of oxygen and pharyngeal gas concentrations were observed with both techniques, the standard cannulae were deemed to be a lot less comfortable than THRIVE and made a lot more noise which likely limit the utility of this technique outside of short bursts.
In this study, a standard nasal oxygen cannula used at high flows achieved similar oxygen delivery to THRIVE at the expense of poor comfort and increased noise.
在全身麻醉诱导和镇静之前及期间，通常会给患者补充氧气。这会增加肺部的氧气含量，提高氧气输送，并延长氧饱和度下降的时间。专有的经鼻湿化快速充气通气交换（THRIVE）系统可输送温热且湿润的氧气，已在围手术期和重症监护环境中得到广泛研究，并已证明能显著延长氧饱和度下降时间，作为一种通气支持手段。目前，传统鼻氧管以最大流速使用时，只能短时间使用，因为患者耐受性较差。然而，缺乏关于该技术使用情况的数据。我们假设，在这种情况下，以最大流速使用的传统鼻氧管输送氧气的效果与THRIVE系统相当。
我们设计了一项交叉志愿者可行性研究。参与者为10名健康麻醉医生。我们通过测量经皮氧含量和咽部氧浓度，比较了两种氧气输送方法。记录舒适度和噪音水平。在两组之间比较上述参数。
我们观察到，高流量使用的标准氧管输送氧气的效果及组织氧合性能与专有的THRIVE系统相当。然而，它们的舒适度较低，噪音更大。
据作者所知，本研究首次研究了以最大流速使用的传统鼻氧管的氧气输送情况，并与经过充分研究的THRIVE技术进行了比较。虽然两种技术观察到的经皮氧分压和咽部气体浓度相似，但标准氧管被认为比THRIVE舒适度低得多，噪音也大得多，这可能限制了该技术在短时间使用之外的实用性。
在本研究中，高流量使用的标准鼻氧管实现了与THRIVE相似的氧气输送，但舒适度较差且噪音增加。
