Liu Jianxia, Xiong Ling, Li Haisu, Du Min, Ru Xue, Xu Ying
Children's Hospital of Chongqing Medical University, Chongqing, China.
National Clinical Research Center for Child Health and Disorders, Chongqing, China.
Front Med (Lausanne). 2023 Apr 5;10:1169345. doi: 10.3389/fmed.2023.1169345. eCollection 2023.
This study aimed to compare the use of the STRIVE Hi technique with 70 and 100% oxygen concentrations in children with 1st or 2nd degree laryngeal obstruction undergoing suspension laryngoscopic surgery.
Children aged 1 month to 6 years scheduled for suspension laryngoscopic surgery with spontaneous respiration were randomly divided into the 70% oxygen concentration group (HFNO70% group) and the 100% oxygen concentration group (HFNO100% group). The data recorded for all the patients included age and sex, comorbidities, preoperative physiological status, methods of induction and maintenance of anesthesia, course of the disease and surgical options, and duration of operation. The primary endpoint was the lowest oxygen saturations during the surgery. The secondary endpoints included the partial pressure of oxygen PaO, the arterial pressure of carbon dioxide PaCO, the peak transcutaneous carbon dioxide PtcCO, and the incidence of desaturation (defined as SpO < 90%) or hypercarbia (PtcCO > 65 mmHg).
A total of 80 children with 1st or 2nd degree laryngeal obstruction were included in the analysis. The median [IQR (range)] duration of spontaneous ventilation using STRIVE Hi was 52.5 [40-60 (30-170)]min and 62.5 [45-81 (20-200)]min in the HFNO 70% and HFNO 100% groups, respectively ( = 0.99); the lowest oxygen saturation recorded during the operation was 97.8 ± 2.1% and 96.8 ± 2.5%, respectively ( = 0.053); the mean PaO at the end of surgery was 184.6 ± 56.3 mmHg and 315.2 ± 101.3 mmHg, respectively ( < 0.001); and the peak transcutaneous CO was 58.0 ± 13.0 mmHg and 60.4 ± 10.9 mmHg, respectively ( = 0.373), despite a long operation time.
STRIVE Hi had a positive effect on children undergoing tubeless laryngeal surgery with spontaneous ventilation, and for children with 1st or 2nd degree laryngeal obstruction, there was no significant difference in maintaining the intraoperative oxygenation between the 70 and 100% oxygen concentration groups. The 100% oxygen concentration group showed significant hyperoxia, which has been proven to be associated with multiple organ damage. Using a relatively lower oxygen concentration of 70% can effectively reduce the hazards associated with hyperoxia compared to 100% oxygen concentration.
[www.chictr.org.cn], identifier [CHICTR2200064500].
本研究旨在比较STRIVE Hi技术在1度或2度喉梗阻患儿行支撑喉镜手术时使用70%和100%氧浓度的情况。
计划行支撑喉镜手术且自主呼吸的1个月至6岁儿童被随机分为70%氧浓度组（HFNO70%组）和100%氧浓度组（HFNO100%组）。记录所有患者的年龄、性别、合并症、术前生理状态、麻醉诱导和维持方法、病程及手术方式以及手术时长。主要终点是手术期间的最低氧饱和度。次要终点包括氧分压（PaO）、动脉二氧化碳分压（PaCO）、经皮二氧化碳峰值（PtcCO）以及血氧饱和度降低（定义为SpO＜90%）或高碳酸血症（PtcCO＞65 mmHg）的发生率。
共80例1度或2度喉梗阻患儿纳入分析。HFNO 70%组和HFNO 100%组使用STRIVE Hi进行自主通气的中位[四分位间距（范围）]时长分别为52.5 [40 - 60（30 - 170）]分钟和62.5 [45 - 81（20 - 200）]分钟（P = 0.99）；手术期间记录到的最低氧饱和度分别为97.8 ± 2.1%和96.8 ± 2.5%（P = 0.053）；手术结束时的平均PaO分别为184.6 ± 56.3 mmHg和315.2 ± 101.3 mmHg（P＜0.001）；经皮二氧化碳峰值分别为58.0 ± 13.0 mmHg和60.4 ± 10.9 mmHg（P = 0.373），尽管手术时间较长。
STRIVE Hi对行自主通气的无管喉手术患儿有积极作用，对于1度或2度喉梗阻患儿，70%和100%氧浓度组在维持术中氧合方面无显著差异。100%氧浓度组出现明显的高氧血症，已证实其与多器官损伤有关。与100%氧浓度相比，使用相对较低的70%氧浓度可有效降低与高氧血症相关的危害。
