From the Department of Anesthesiology, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Anesthesiology, Shanghai Skin Disease Hospital, School of Medicine, Tongji University, Shanghai, China.
Anesth Analg. 2024 Feb 1;138(2):456-464. doi: 10.1213/ANE.0000000000006678. Epub 2024 Oct 24.
Hypoxia often occurs due to shared airway and anesthetic sedation-induced hypoventilation in patients receiving flexible bronchoscopy (FB) under deep sedation. Previous evidence has shown that supraglottic jet oxygenation and ventilation (SJOV) via Wei nasal jet tube (WNJ) reduces the incidence of hypoxia during FB. This study aimed to investigate the extent to which SJOV via WNJ could decrease the incidence of hypoxia in patients under deep sedation as compared to oxygen supplementation via WNJ alone or nasal catheter (NC) for oxygen supplementation during FB.
This was a single-center 3-arm randomized controlled trial (RCT). Adult patients scheduled to undergo FB were randomly assigned to 3 groups: NC (oxygen supplementation via NC), low-pressure low-flow (LPLF) (low-pressure oxygen supplementation via WNJ alone), or SJOV (high-pressure oxygen supplementation via WNJ). The primary outcome was hypoxia (defined as peripheral saturation of oxygen [Sp o2 ] <90% lasting more than 5 seconds) during FB. Secondary outcomes included subclinical respiratory depression or severe hypoxia, and rescue interventions specifically performed for hypoxia treatment. Other evaluated outcomes were sore throat, xerostomia, nasal bleeding, and SJOV-related barotraumatic events.
One hundred and thirty-two randomized patients were included in 3 interventions (n = 44 in each), and all were included in the final analysis under intention to treat. Hypoxia occurred in 4 of 44 patients (9.1%) allocated to SJOV, compared to 38 of 44 patients (86%) allocated to NC, with a relative risk (RR) for hypoxia, 0.11; 98% confidence interval (CI), 0.02-0.51; P < .001; or to 27 of 44 patients (61%) allocated to LPLF, with RR for hypoxia, 0.15; 95% CI, 0.04-0.61; P < .001, respectively. The percentage of subclinical respiratory depression was also significantly diminished in patients with SJOV (39%) compared with patients with NC (100%) or patients with LPLF (96%), both P < .001. In SJOV, no severe hypoxia event occurred. More remedial interventions for hypoxia were needed in the patients with NC. Higher risk of xerostomia was observed in patients with SJOV. No severe adverse event was observed throughout the study.
SJOV via WNJ effectively reduces the incidence of hypoxia during FB under deep sedation.
在深度镇静下接受软性支气管镜（FB）检查的患者，由于气道共享和麻醉镇静诱导的通气不足，常发生缺氧。先前的证据表明，通过魏氏鼻喷气管（WNJ）进行的声门上喷射氧合和通气（SJOV）可降低 FB 期间缺氧的发生率。本研究旨在比较在深度镇静下接受 FB 检查的患者，通过 WNJ 进行 SJOV 与单独通过 WNJ 进行低压力低流量（LPLF）给氧或通过鼻导管（NC）给氧相比，SJOV 降低缺氧发生率的程度。
这是一项单中心 3 臂随机对照试验（RCT）。计划接受 FB 的成年患者被随机分配到 3 组：NC（通过 NC 给氧）、LPLF（单独通过 WNJ 进行低压力给氧）或 SJOV（通过 WNJ 进行高压力给氧）。主要结局是 FB 期间发生的缺氧（定义为外周血氧饱和度[Sp o2 ]持续 5 秒以上<90%）。次要结局包括亚临床呼吸抑制或严重缺氧，以及专门用于缺氧治疗的抢救干预措施。其他评估结局包括咽痛、口干、鼻出血和 SJOV 相关气压伤事件。
132 名随机患者被纳入 3 种干预措施（每组 44 名患者），所有患者均根据意向治疗原则纳入最终分析。SJOV 组 44 名患者中有 4 名（9.1%）发生缺氧，NC 组 44 名患者中有 38 名（86%）发生缺氧，缺氧的相对风险（RR）为 0.11；95%置信区间（CI）为 0.02-0.51；P<0.001；或 LPLF 组 44 名患者中有 27 名（61%）发生缺氧，RR 为 0.15；95%CI 为 0.04-0.61；P<0.001。SJOV 组的亚临床呼吸抑制发生率也明显低于 NC 组（100%）或 LPLF 组（96%），RR 为 0.39；95%CI 为 0.04-0.61；P<0.001。SJOV 组中没有发生严重缺氧事件。NC 组的患者需要更多的缺氧补救干预措施。SJOV 组的口干风险较高。整个研究过程中未观察到严重不良事件。
通过 WNJ 进行 SJOV 可有效降低深度镇静下 FB 期间的缺氧发生率。
