High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children: a double-blind randomised controlled trial
High inspired oxygen fraction impairs lung volume and ventilation heterogeneity in healthy children: a double-blind randomised controlled trial
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DOI：
10.1016/j.bja.2019.01.036
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发表时间：
2019-05-01
影响因子：
9.8
通讯作者：
Habre, Walid
中科院分区：
文献类型：
--
作者：
de la Grandville, Beatrice;Petak, Ferenc;Habre, Walid
背景：虽然高吸入氧分数（FiO(2)）常用于儿科麻醉，但其对术后肺功能的影响尚不清楚。我们比较了术中随机接受低或高 FiO(2) 治疗的麻醉儿童的肺容量、通气不均匀性和呼吸力学。方法：在一项双盲随机对照试验中，计划进行择期手术的儿童在麻醉诱导和苏醒期间被随机分配为 FiO(2) 100% (n=29) 或 FiO(2) 80% (n=29)。维持麻醉期间，诱导/苏醒时分配 FiO(2)=100% 的参与者接受 FiO(2)=80%（FiO(2)>0.8 组）；那些在诱导/苏醒时随机分配至 FiO(2)=80% 的患者在术中接受 FiO(2)=35%（FiO(2) [0.8 -> 0.35 组]）。在自主呼吸期间，我们通过多次呼吸氮气冲洗来测量（i）功能残气量（FRC）和肺清除指数（通气不均匀性）； (ii) 手术前、出院后和手术后 24 小时通过强制振荡测量的气道阻力和呼吸组织弹性。报告平均值（95% 置信区间）。结果：58 名儿童（12.9 [12.3-13.5] 岁）被随机分组； 22/29（高组）和 21/29（低组）儿童完成了连续多次呼吸氮气冲刷测量。恢复出院后，FiO(2)>0.8 组的 FRC 下降（-12.0 [-18.5 至 -5.5]%；P=0.01），但 24 小时后恢复正常。出院后两组通气不均匀性均有所增加，但 FiO(2)>0.8 组术后 24 h 仍持续存在（6.1 [2.5-9.8%]%；P=0.02）。在任何时间点，各组之间的气道阻力和呼吸弹性没有差异。结论：FiO(2)>0.8导致术后即刻肺容量减少，并伴有持续的通气不均匀性。这些数据表明，对于肺部正常的麻醉儿童，应避免 FiO(2)>0.8。
Background: Although a high inspired oxygen fraction (FiO(2)) is commonly used in paediatric anaesthesia, the impact on postoperative lung function is unclear. We compared lung volume, ventilation heterogeneity, and respiratory mechanics in anaesthetised children randomised to receive low or high FiO(2) intraoperatively.Methods: In a double-blind randomised controlled trial, children scheduled for elective surgery were randomly assigned FiO(2) 100% (n=29) or FiO(2) 80% (n=29) during anaesthesia induction and emergence. During maintenance of anaesthesia, participants assigned FiO(2)=100% at induction/emergence received FiO(2)=80% (FiO(2)>0.8 group); those randomised to FiO(2)=80% at induction/emergence received FiO(2)=35% intraoperatively (FiO(2) [0.8 -> 0.35 group]). During spontaneous breathing, we measured the (i) functional residual capacity (FRC) and lung clearance index (ventilation inhomogeneity) by multiple-breath nitrogen washout; and (ii) airway resistance and respiratory tissue elastance by forced oscillations, before operation, after discharge from the recovery room, and 24 h after operation. Mean (95% confidence intervals) are reported.Results: Fifty eight children (12.9 [12.3-13.5] yr) were randomised; 22/29 (high group) and 21/29 (low group) children completed serial multiple-breath nitrogen washout measurements. FRC decreased in the FiO(2)>0.8 group after discharge from recovery (-12.0 [-18.5 to -5.5]%; P=0.01), but normalised 24 h later. Ventilation inhomogeneity increased in both groups after discharge from recovery, but persisted in the FiO(2)>0.8 group 24 h after surgery (6.1 [2.5-9.8%]%; P=0.02). Airway resistance and respiratory elastance did not differ between the groups at any time point.Conclusions: FiO(2)>0.8 decreases lung volume in the immediate postoperative period, accompanied by persistent ventilation inhomogeneity. These data suggest that FiO(2)>0.8 should be avoided in anaesthetised children with normal lungs.