小儿患者全身麻醉期间的氧合实践：欧洲、美国、澳大利亚和新西兰的一项国际调查
Oxygenation Practices During General Anesthesia in Pediatric Patients: An International Survey in Europe, USA, Australia, and New Zealand.
作者信息
van Wijk Jan J, Hoeks Sanne E, Reiss Irwin K M, Stolker Robert Jan, Staals Lonneke M
机构信息
Department of Anesthesiology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, the Netherlands.
出版信息
Paediatr Anaesth. 2025 Aug;35(8):643-648. doi: 10.1111/pan.15139. Epub 2025 Jun 9.
AIMS
At present, there is a growing body of knowledge regarding the benefits and risks associated with oxygen use in medical practice. In the perioperative period, high fractions of inspiratory oxygen are used during airway management. However, oxygen can have direct toxic effects, as well as systemic effects. In different fields of medicine, protocols exist to limit the use of oxygen, for example, in the intensive care unit and emergency department. However, in pediatric perioperative care, such protocols do not exist. We conducted an international survey among pediatric anesthesiologists to assess their daily practices regarding oxygen use during non-cardiac surgery. The objective of this survey was to determine self-reported perioperative oxygen use across several key areas: the default oxygen settings on anesthesia machines, the prevalence of preoxygenation, the fraction of inspiratory oxygen used intraoperatively, and considerations regarding the intraoperative administration of oxygen.
METHODS
An online digital survey consisting of up to 21 questions in LimeSurvey was developed and sent to 5667 members of various international pediatric anesthesia societies (ESPA, APAGBI, SPA, SPANZA).
RESULTS
A total of 828 responses were received (response rate 15%). The median reported default inspiratory oxygen (FiO) value of anesthesia machines was 100% (IQR 30%-100%). Preoxygenation was used by 50% of the respondents, usually with 100% oxygen. 87% of respondents reported to titrate FiO intraoperatively, mainly based on pulse oximetry values. Median standard percentage of oxygen intraoperatively was 35% (IQR 30%-40%).
CONCLUSIONS
Oxygen administration practices during pediatric anesthesia are hardly regulated. There are opportunities to further limit the use of oxygen. For instance, default settings can be lowered, and intraoperative FiO can be further titrated, mainly based on SpO.
目的
目前，关于医学实践中氧疗的益处和风险，人们的认识日益增多。在围手术期，气道管理过程中会使用高浓度的吸入氧。然而，氧可能具有直接毒性作用以及全身影响。在医学的不同领域，存在限制氧使用的方案，例如在重症监护病房和急诊科。然而，在儿科围手术期护理中，此类方案并不存在。我们对儿科麻醉医生进行了一项国际调查，以评估他们在非心脏手术期间氧使用的日常实践。本次调查的目的是确定在几个关键领域自我报告的围手术期氧使用情况：麻醉机上的默认氧设置、预充氧的普及率、术中使用的吸入氧分数，以及关于术中氧给药的考虑因素。
方法
在LimeSurvey中开发了一个包含多达21个问题的在线数字调查问卷，并发送给5667名不同国际儿科麻醉学会（欧洲小儿麻醉学会、法国小儿麻醉与重症监护学会、西班牙小儿麻醉学会、澳大利亚新西兰小儿麻醉学会）的成员。
结果
共收到828份回复（回复率15%）。报告的麻醉机默认吸入氧（FiO）值中位数为100%（四分位间距30%-100%）。50%的受访者使用预充氧，通常使用100%的氧。87%的受访者报告在术中根据脉搏血氧饱和度值滴定FiO。术中氧的标准百分比中位数为35%（四分位间距30%-40%）。
结论
儿科麻醉期间的氧给药实践几乎没有规范。有进一步限制氧使用的机会。例如，可以降低默认设置，并主要根据SpO进一步滴定术中FiO。
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