Carron Michele, Tamburini Enrico, Safaee Fakhr Bijan, De Cassai Alessandro, Linassi Federico, Navalesi Paolo
Department of Medicine - DIMED, Section of Anaesthesiology and Intensive Care, University of Padua, Padua, Italy.
Institute of Anaesthesia and Intensive Care - Azienda Ospedale Università Padova, Padua, Italy.
BJA Open. 2022 Oct 18;4:100098. doi: 10.1016/j.bjao.2022.100098. eCollection 2022 Dec.
The use of high-flow nasal oxygen (HFNO) has the potential to improve patient safety by limiting hypoxaemia during gastrointestinal endoscopy. The degree of benefit is not adequately established.
English language literature searches of PubMed, Scopus, Web of Science, and Cochrane Library electronic databases were performed to identify randomised controlled trials comparing HFNO and conventional oxygen therapy (COT) for patients undergoing gastrointestinal endoscopy under deep sedation. The primary endpoint was the incidence of hypoxic events observed during endoscopic procedures. The secondary endpoints were the incidence of recourse to rescue manoeuvres, procedure interruption, and adverse events. A meta-analysis and a trial sequence analysis were performed.
A total of 2867 patients from six randomised controlled trials were considered. Desaturation was observed in 5.2% and 27.2% of patients receiving HFNO and COT, respectively. Desaturation <90% was observed in 1.8% and 12.6% of the patients receiving HFNO and COT, respectively. In the subgroup analysis, desaturation occurrence was lower during HFNO than during COT in non-obese patients (2.2% 25.2%) and obese patients (22.9% 43.3%). Desaturation occurrence was lower during maximum (3.6% 26.9%) and minimum (15.9% 29.8%) HFNO therapy than during COT. HFNO showed a lower recurrence to rescue manoeuvres rate (4.7% 34.3%), a lower procedure interruption rate (0.4% 6.7%), and a lower adverse events rate (18.7% 21%) than COT. A high level of heterogeneity between the studies precluded confidence in drawing inference from the meta-analysis.
The evidence reviewed suggests that compared with COT, HFNO has fewer hypoxaemic events during gastrointestinal endoscopy, but this may not apply to all patients and clinical scenarios.
在胃肠内镜检查期间，使用高流量鼻导管给氧（HFNO）有通过限制低氧血症来提高患者安全性的潜力。获益程度尚未得到充分证实。
对PubMed、Scopus、Web of Science和Cochrane图书馆电子数据库进行英文文献检索，以识别比较HFNO与传统氧疗（COT）用于深度镇静下胃肠内镜检查患者的随机对照试验。主要终点是内镜检查过程中观察到的低氧事件发生率。次要终点是采取抢救措施、手术中断和不良事件的发生率。进行了荟萃分析和试验序贯分析。
共纳入来自6项随机对照试验的2867例患者。接受HFNO和COT的患者中，分别有5.2%和27.2%出现血氧饱和度下降。接受HFNO和COT的患者中，分别有1.8%和12.6%的患者血氧饱和度<90%。在亚组分析中，非肥胖患者（2.2%对25.2%）和肥胖患者（22.9%对43.3%）中，HFNO期间血氧饱和度下降的发生率低于COT期间。在HFNO最大剂量（3.6%对26.9%）和最小剂量（15.9%对29.8%）治疗期间，血氧饱和度下降的发生率低于COT期间。与COT相比，HFNO的抢救措施复发率较低（4.7%对34.3%）、手术中断率较低（0.4%对6.7%）、不良事件发生率较低（18.7%对21%）。研究之间的高度异质性使得无法从荟萃分析中得出可靠的推论。
所审查的证据表明，与COT相比，HFNO在胃肠内镜检查期间的低氧血症事件较少，但这可能不适用于所有患者和临床情况。
