在预计有困难气道的患者中，麻醉诱导期间压力控制通气与手动通气的比较：一项前瞻性随机对照试验。
Comparison between pressure-controlled and manual ventilation during anesthetic induction in patients with expected difficult airway: A prospective randomized controlled trial.
机构信息
Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
出版信息
Medicine (Baltimore). 2023 Aug 25;102(34):e35007. doi: 10.1097/MD.0000000000035007.
BACKGROUND
Gastric insufflation can cause gastric regurgitation, which may be exacerbated in patients who are expected to have difficult airways. The purpose of this study was to investigate the difference in respiratory parameters and the frequency of gastric insufflation according to the ventilation mode during the anesthestic induction on patients who were predicted to have difficult facemask ventilation.
METHODS
A total of eighty patients with expected airway difficulties were included. Patient were allocated to 2 groups (n = 40 each). In the manual ventilation group, ventilation was performed by putting a mask on the patient's face with 1-hand and adjusting the pressure limiting valve to 15 cm H2O. In the pressure-controlled ventilation group, a mask was held in place using 2-handed jaw-thrust maneuver. The pressure-controlled ventilation was applied and peak inspiration pressure was adjusted to achieve a tidal volume of 6 to 8 mL/kg. The primary outcome was the difference of the peak airway pressure between 2 groups every 30 seconds for 120 seconds duration of mask ventilation. We also evaluated respiratory variables including peak airway pressure, End-tidal carbon dioxide and also gastric insufflation using ultrasonography.
RESULTS
The pressure-controlled ventilation group demonstrated lower peak airway pressure than the manual ventilation group (P = .005). End-tidal carbon dioxide was higher in the pressure-controlled ventilation group (P = .012). The incidence of gastric insufflation assessed by real-time ultrasonography of the gastric antrum was higher in the manual ventilation group than in the pressure-controlled ventilation group [3 (7.5%) vs 17 (42.5%), risk ratio (95% confidence interval): 0.06 to 0.56, P = .003].
CONCLUSIONS
Pressure-controlled ventilation during facemask ventilation in patients who were expected to have difficult airways showed a lower gastric insufflation rate with low peak airway pressure compared to manual ventilation.
背景
胃充气可导致胃反流，对于预计有困难气道的患者，这种情况可能会加重。本研究的目的是探讨在预计面罩通气困难的患者中，根据通气模式，在麻醉诱导期间呼吸参数和胃充气的差异。
方法
共纳入 80 例预计气道困难的患者。患者分为 2 组（每组 40 例）。在手动通气组中，通过用一只手将面罩放在患者的脸上，并将压力限制阀调节至 15cmH2O 来进行通气。在压力控制通气组中，使用双手托下颌手法将面罩固定到位。应用压力控制通气，并调整峰吸气压以实现 6 至 8mL/kg 的潮气量。主要结局是面罩通气 120 秒内，两组每 30 秒的峰气道压差异。我们还评估了包括峰气道压、呼气末二氧化碳在内的呼吸变量，以及使用超声评估胃充气情况。
结果
压力控制通气组的峰气道压低于手动通气组（P =.005）。压力控制通气组的呼气末二氧化碳更高（P =.012）。实时超声评估胃窦的胃充气发生率，手动通气组高于压力控制通气组[3（7.5%）比 17（42.5%），风险比（95%置信区间）：0.06 至 0.56，P =.003]。
结论
对于预计有困难气道的患者，在面罩通气期间进行压力控制通气与手动通气相比，胃充气率较低，峰气道压较低。
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