比较肥胖患者面罩通气时三种呼气末压力水平对胃充气的影响：一项随机对照试验。
Comparing the effect of three levels of end-expiratory pressure during facemask ventilation on gastric insufflation in patients with obesity: a randomized controlled trial.
作者信息
Mostafa Maha, Hasanin Ahmed, Zakaria Mohamed M, Kandel Hamza, Hamimy Walid, Abougabal Ayman, Elshal Mamdouh M
机构信息
Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt.
Department of Anesthesia and Critical Care Medicine, National Cancer Institute, Cairo University, Cairo, Egypt.
出版信息
J Anesth. 2025 Jun 30. doi: 10.1007/s00540-025-03531-9.
BACKGROUND
We compared the effect of three levels of end-expiratory pressure on the incidence of gastric insufflation during face-mask ventilation in patients with obesity.
METHODS
This randomized controlled trial included adult obese patients undergoing elective non-cardiac surgery under general anesthesia with neuromuscular blockade. Patients were randomized to receive either zero-end-expiratory pressure (ZEEP group), 4-cmHO positive end-expiratory pressure (PEEP) (low-PEEP group), or 8-cmHO PEEP (high-PEEP group) during volume-controlled mask ventilation. Gastric antral cross-sectional area (CSA) was assessed using ultrasonography before induction of anesthesia and after intubation. The percentage of change (delta) in the CSA was calculated and gastric insufflation was considered significant when the delta CSA was > 30%. The primary outcome was the incidence of gastric insufflation. Secondary outcomes were antral CSA before induction of anesthesia and after intubation in addition to ventilatory variables (end-tidal CO, peak airway pressure, and tidal volume) during face-mask ventilation.
RESULTS
We analyzed data from 160 patients. The antral CSA increased after intubation in all groups. The incidence of gastric insufflation was higher in the high-PEEP group (32/54[59%]) than that in the ZEEP group (6/52[12%]) and low-PEEP group (15/54[28%]). Delta CSA, antral CSA after intubation, and incidence of gastric insufflation were not significantly different between the ZEEP and low-PEEP groups. Ventilatory variables were comparable between the groups.
CONCLUSION
In obese paralyzed patients, gastric insufflation can occur during face-mask ventilation whatever the level of end-expiratory pressure; however, the use of ZEEP or 4-cmHO PEEP was associated with lower incidence of gastric insufflation compared to 8-cmHO PEEP.
CLINICAL TRIAL REGISTRATION
Clinical trial registration at clinicaltrials.gov NCT05979129. https://classic.
CLINICALTRIALS
gov/ct2/show/NCT05979129.
背景
我们比较了三种呼气末压力水平对肥胖患者面罩通气期间胃充气发生率的影响。
方法
这项随机对照试验纳入了在全身麻醉下接受择期非心脏手术且使用神经肌肉阻滞剂的成年肥胖患者。在容量控制面罩通气期间，患者被随机分配接受零呼气末压力（ZEEP组）、4 cmH₂O呼气末正压（PEEP）（低PEEP组）或8 cmH₂O PEEP（高PEEP组）。在麻醉诱导前和插管后使用超声评估胃窦横截面积（CSA）。计算CSA的变化百分比（delta），当delta CSA > 30%时，认为胃充气显著。主要结局是胃充气的发生率。次要结局包括麻醉诱导前和插管后的胃窦CSA，以及面罩通气期间的通气变量（呼气末二氧化碳、气道峰压和潮气量）。
结果
我们分析了160例患者的数据。所有组插管后胃窦CSA均增加。高PEEP组胃充气发生率（32/54[59%]）高于ZEEP组（6/52[12%]）和低PEEP组（15/54[28%]）。ZEEP组和低PEEP组之间的delta CSA、插管后胃窦CSA和胃充气发生率无显著差异。各组通气变量具有可比性。
结论
在肥胖麻痹患者中，无论呼气末压力水平如何，面罩通气期间都可能发生胃充气；然而，与8 cmH₂O PEEP相比，使用ZEEP或4 cmH₂O PEEP与较低的胃充气发生率相关。
临床试验注册
在clinicaltrials.gov上注册的临床试验NCT05979129。https://classic.clinicaltrials.gov/ct2/show/NCT05979129 。
Zotero 插件