鼻持续气道正压通气与简易面罩给氧用于在丙泊酚全身麻醉下未行气管插管的成年肥胖及阻塞性睡眠呼吸暂停患者结肠镜检查：一项随机对照试验

Nasal continuous positive pressure versus simple face mask oxygenation for adult obese and obstructive sleep apnea patients undergoing colonoscopy under propofol-based general anesthesia without tracheal intubation: A randomized controlled trial.

作者信息

Cukierman Daniel S, Perez Manuel, Guerra-Londono Juan J, Carlson Richard, Hagan Katherine, Ghebremichael Semhar, Hagberg Carin, Ge Phillip S, Raju Gottumukkala S, Rhim Andrew, Cata Juan P

机构信息

Department of Anesthesiology, Hospital Bernardino Rivadavia, Universidad de Buenos Aires, Buenos Aires, Argentina.

Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Department of Gastroenterology, Hepatology, and Nutrition, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA.

出版信息

J Clin Anesth. 2023 Oct;89:111196. doi: 10.1016/j.jclinane.2023.111196. Epub 2023 Jul 3.

DOI:10.1016/j.jclinane.2023.111196

PMID:37406462

Abstract

STUDY OBJECTIVE

To determine if a nasal positive airway pressure (nasal CPAP) mask would decrease the number of hypoxemic events in obese and obstructive sleep apnea patients undergoing colonoscopy.

DESIGN

Single-center prospective randomized controlled trial.

SETTING

Tertiary academic center.

PATIENTS

We enrolled 109 patients with diagnosis of obesity and/or obstructive sleep apnea scheduled to undergo colonoscopy under propofol general anesthesia without planned tracheal intubation.

INTERVENTION

Patients were randomly allocated (1:1 ratio) to receive supplementary oxygen at a flow of 10 L/min, either through a nasal CPAP or a simple facemask.

MEASUREMENTS

The primary endpoint was the difference in the mean percentage of time spent with oxygen saturation below 90% between the two groups. Secondary outcomes included the need for airway maneuvers/interventions, average SpO2 during the case, duration and severity of oxygen desaturation, incidence and duration of procedural interruptions, and satisfaction and tolerance scores.

MAIN RESULTS

54 were allocated to the simple face mask and 55 to the nasal CPAP mask arms, respectively. A total of 6 patients experienced a hypoxemic event. Among these patients, the difference in the percentage of time spent with oxygen saturation below 90% was not clinically relevant (p = 1.0). However, patients in the nasal CPAP group required less chin lift (20% vs. 42.6%; p = 0.01) and oral cannula insertion (12.7% vs.29.6%; p = 0.03). The percentage of patients with at least one airway maneuver was higher in the simple face mask arm (68.5% vs. 41.8%; p = 0.005). Patient tolerance to device score was lower in the nasal CPAP group (8.85 vs. 9.56; p = 0.003).

CONCLUSIONS

A nasal CPAP did not prevent hypoxemia and should not be used routinely for colonoscopy in obese or OSA patients if a simple face mask is an alternative therapy. However, potential advantages of its use include fewer airway maneuvers or interventions, which may be desirable in certain clinical settings.

TRIAL REGISTRATION

Clinicaltrials.gov, identifier: NCT05175573.

摘要

研究目的

确定鼻持续气道正压通气（鼻CPAP）面罩是否会减少接受结肠镜检查的肥胖和阻塞性睡眠呼吸暂停患者的低氧血症事件数量。

设计

单中心前瞻性随机对照试验。

地点

三级学术中心。

患者

我们纳入了109例诊断为肥胖和/或阻塞性睡眠呼吸暂停且计划在丙泊酚全身麻醉下进行结肠镜检查且无气管插管计划的患者。

干预措施

患者被随机分配（1:1比例），通过鼻CPAP或简单面罩接受10L/min的补充氧气。

测量指标

主要终点是两组之间氧饱和度低于90%的平均时间百分比差异。次要结局包括气道操作/干预的需求、术中平均SpO2、氧饱和度降低的持续时间和严重程度、手术中断的发生率和持续时间以及满意度和耐受性评分。

主要结果

分别有54例患者被分配到简单面罩组和55例患者被分配到鼻CPAP面罩组。共有6例患者发生低氧血症事件。在这些患者中，氧饱和度低于90%的时间百分比差异无临床意义（p = 1.0）。然而，鼻CPAP组患者需要较少的抬颏操作（20%对42.6%；p = 0.01）和插入口咽通气管操作（12.7%对29.6%；p = 0.03）。简单面罩组至少进行一次气道操作的患者百分比更高（68.5%对41.8%；p = 0.005）。鼻CPAP组患者对设备的耐受性评分较低（8.85对9.56；p = 0.003）。