Franchi L M, Maggi J C, Nussbaum E
Memorial Miller Children's Hospital, Department of Pediatrics, University of California, Irvine, Long Beach 90801-1428.
Pediatr Pulmonol. 1993 Sep;16(3):153-7. doi: 10.1002/ppul.1950160303.
In recent years flexible fiberoptic bronchoscopy (FFB) has been applied to children for diagnostic and therapeutic purposes. Sedation during FFB, along with introduction of the bronchoscope into the pediatric airway, may cause hypoventilation, leading to hypoxia and desaturation, even in the presence of oxygen supplementation. Arterial oxygen saturation is usually monitored by pulse oximetry (SpO2) during FFB. End-tidal PCO2 (P(etCO2)) monitoring is not routinely used. Twenty-two pediatric patients (15 days to 18 years old) undergoing FFB and receiving supplemental oxygen were studied prospectively and had continuous P(etCO2) and SpO2 measured before and during the procedure (bronchoscope at the carina or either main bronchus). Mean P(etCO2) (+/- SD) decreased from 33.9 (+/- 6.0) mmHg before to 27.1 (+/- 12.1) mmHg during the procedure (P < 0.024). Concomitantly, mean SpO2 (+/- SD) also decreased from 99.9 (+/- 0.4)% before to 95.7 (+/- 11.1)% during the procedure (P < 0.015). P(etCO2) changes seemed to precede the variations in SpO2, especially in young patients who experienced significant desaturation and decompensation during FFB. We conclude that PetCO2 and SpO2 decrease during FFB in children, even with supplemental oxygen. We speculate that this reflects airway obstruction by the instrument. Further studies are needed to assess the utility of PetCO2 monitoring in pediatric FFB.
近年来，可弯曲纤维支气管镜（FFB）已应用于儿童的诊断和治疗。FFB检查期间的镇静以及将支气管镜插入小儿气道，即使在补充氧气的情况下，也可能导致通气不足，进而引起缺氧和血氧饱和度下降。FFB检查期间通常通过脉搏血氧饱和度仪（SpO2）监测动脉血氧饱和度。呼气末二氧化碳分压（P(etCO2)）监测并非常规使用。我们对22例接受FFB检查并吸氧的儿科患者（年龄在15天至18岁之间）进行了前瞻性研究，并在检查前及检查过程中（支气管镜位于隆突或任一主支气管时）连续测量P(etCO2)和SpO2。检查过程中，平均P(etCO2)（±标准差）从检查前的33.9（±6.0）mmHg降至27.1（±12.1）mmHg（P < 0.024）。与此同时，平均SpO2（±标准差）也从检查前的99.9（±0.4）%降至检查过程中的95.7（±11.1）%（P < 0.015）。P(etCO2)的变化似乎先于SpO2的变化，尤其是在FFB检查期间出现明显血氧饱和度下降和失代偿的年轻患者中。我们得出结论，即使补充氧气，儿童FFB检查期间PetCO2和SpO2仍会下降。我们推测这反映了仪器导致的气道阻塞。需要进一步研究以评估PetCO2监测在儿科FFB检查中的效用。
