Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil: A randomised controlled clinical trial.
Supraglottic jet oxygenation and ventilation reduces desaturation during bronchoscopy under moderate to deep sedation with propofol and remifentanil: A randomised controlled clinical trial.
复制标题
DOI：
10.1097/eja.0000000000001401
复制
发表时间：
2021-03-01
影响因子：
3.6
通讯作者：
Wei H
中科院分区：
文献类型：
--
作者：
Zha B;Wu Z;Xie P;Xiong H;Xu L;Wei H
在传统的异丙酚镇静下，通过鼻入路进行可弯曲支气管镜检查时，经常会出现低氧血症。本研究探讨了在使用丙泊酚、利多卡因和瑞芬太尼混合液进行中度至深度静脉镇静的情况下，使用Wei鼻喷射管（WNJ）进行声门上喷射氧合和通气（SJOV）在减少接受支气管镜检查的患者低氧血症方面的潜在获益。我们的主要目的是评估在使用丙泊酚和瑞芬太尼进行中度至重度镇静的情况下，在柔性支气管镜检查期间通过WNJ进行SJOV的有效性和并发症。随机对照临床试验。中国人民解放军第180医院，泉州，2019年6月1日至11月1日。共研究了280例接受可弯曲支气管镜检查的患者，年龄≥18岁，美国麻醉医师协会身体状况评分为1 - 3。患者被随机分配到两组中的一组，鼻套管氧合（NCO）组（n = 140）使用鼻套管输送氧气（4 l min−1）或SJOV组（n = 140）使用WNJ连接手动喷射呼吸机提供SJOV，驱动压力为103 kPa，呼吸频率为20 min−1，FiO 2 1.0，吸气：呼气（I：E）比为1：2。 主要结局是手术过程中血氧饱和度下降（定义为SpO 2 <90%）的发生率。 还记录了与镇静或SJOV相关的其他不良事件。与NCO组相比，SJOV组的氧饱和度下降发生率较低（NCO组为37.0%，SJOV组为13.1%）（P <0.001）。 SJOV组患者在1 min时口干的发生率（13.1% vs. 1.5%，P <0.001）高于30 min时（1.5% vs. 0%，P = 0.159）或24 h时（0% vs. 0%）。 两组在咽喉痛、皮下气肿或鼻出血方面无显著差异。与通过鼻插管定期补充氧气相比，在使用丙泊酚和瑞芬太尼进行中度至深度镇静的情况下，在柔性支气管镜检查期间通过WNJ进行SJOV可显著降低饱和度下降的发生率。SJOV组患者的一过性口干发生率增加。在www.chictr.org.cn上注册（ChiCTR 1900023514）。
Hypoxaemia is frequently seen during flexible bronchoscopies that are done with a nasal approach under the traditional sedation with propofol. This study investigated the potential benefits of supraglottic jet oxygenation and ventilation (SJOV) using the Wei nasal jet tube (WNJ) in reducing hypoxaemia in patients undergoing bronchoscopy under moderate to deep intravenous sedation using a propofol, lidocaine and remifentanil cocktail. Our primary objective was to evaluate the efficacy and complications of SJOV via the WNJ during flexible bronchoscopy under moderate to heavy sedation with propofol and remifentanil. A randomised controlled clinical trial. The 180th Hospital of People's Liberation Army, Quanzhou, China, from 1 June to 1 November 2019. A total of 280 patients aged ≥18 years with American Society of Anesthesiologists’ physical status 1 to 3 undergoing flexible bronchoscopy were studied. Patients were assigned randomly into one of two groups, a nasal cannula oxygenation (NCO) group (n = 140) using a nasal cannula to deliver oxygen (4 l min−1) or the SJOV group (n = 140) using a WNJ connected to a manual jet ventilator to provide SJOV at a driving pressure of 103 kPa, respiratory rate 20 min−1, FiO2 1.0 and inspiratory:expiratory (I:E) ratio 1:2. The primary outcome was an incidence of desaturation (defined as SpO2 < 90%) during the procedure. Other adverse events related to the sedation or SJOV were also recorded. Compared with the NCO group, the incidence of desaturation in the SJOV group was lower (NCO 37.0% vs. SJOV 13.1%) (P < 0.001). Patients in the SJOV group had a higher incidence of a dry mouth at 1 min (13.1% vs. 1.5%, P < 0.001) than at 30 min (1.5% vs. 0%, P = 0.159) or at 24 h (0% vs. 0%). There was no significant difference between the groups in respect of sore throat, subcutaneous emphysema or nasal bleeding. SJOV via a WNJ during flexible bronchoscopy under moderate to deep sedation with propofol and remifentanil significantly reduces the incidence of desaturation when compared with regular oxygen supplementation via a nasal cannula. Patients in the SJOV group had an increased incidence of transient dry mouth. Registered at www.chictr.org.cn (ChiCTR1900023514).