Comparison of high flow nasal oxygen and conventional nasal cannula during gastrointestinal endoscopic sedation in the prone position: a randomized trial
Comparison of high flow nasal oxygen and conventional nasal cannula during gastrointestinal endoscopic sedation in the prone position: a randomized trial
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DOI：
10.1007/s12630-020-01883-2
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发表时间：
2021-01-06
影响因子：
4.2
通讯作者：
Oh, Young Jun
中科院分区：
文献类型：
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作者：
Kim, Seung Hyun;Bang, Seungmin;Oh, Young Jun
目的对俯卧位的老年患者行内镜逆行胆管造影（ERCP）时，深度镇静是一个挑战。本研究探讨了高流量鼻氧（HFNO）给氧系统与常规鼻插管给氧系统在此过程中对氧合的影响。方法采用前瞻性随机试验方法，对俯卧位ERCP患者采用HFNO和常规鼻插管治疗。记录每位患者的最低血氧饱和度（SpO(2)）、低氧血症发生率（定义为SpO(2)低于90%）以及气道干预导致的中断。结果HFNO组手术过程中最低平均（标准差）SpO(2)高于常规对照组[99.8 (0.6)% vs 95.1 (7.3)%；平均差值4.7%；95%置信区间为2.3% ~ 7.1%；p组x时间< 0.001]。手术过程中的最低SpO(2)低于对照组的基线SpO(2)，而HFNO组手术过程中的最低SpO(2)高于基线SpO(2)。低氧血症仅发生在对照组（n = 7; 19%; P = 0.01）。程序中断，包括停止镇静、患者刺激和颌突，仅发生在对照组（n = 9[25%]、n = 10[28%]和n = 10[28%]例，各P = 0.001）。结论与常规鼻插管相比，高流量鼻氧可提供足够的氧合，且不会造成ERCP过程中断，提示高流量鼻氧可作为ERCP过程中的标准给氧方法。
Purpose Deep sedation for endoscopic retrograde cholangiopancreatography (ERCP) can be challenging in elderly patients in the prone position. This study investigated the effect of a high flow nasal oxygen (HFNO) delivery system on oxygenation in this procedure compared with that of conventional nasal cannula oxygen administration.Methods A prospective randomized trial was conducted using HFNO and conventional nasal cannula in patients undergoing ERCP in the prone position. For each patient, the lowest oxygen saturation (SpO(2)), the incidence of hypoxemia defined as an SpO(2) below 90%, and interruptions due to airway interventions were recorded during the procedure.Results The lowest mean (standard deviation) SpO(2) recorded during the procedure was higher in the HFNO group than in the conventional control group [99.8 (0.6)% vs 95.1 (7.3)%; mean difference, 4.7%; 95% confidence interval, 2.3% to 7.1%; P-Group x Time < 0.001]. While the lowest SpO(2) during the procedure was lower than the baseline SpO(2) in the control group, the lowest SpO(2) during the procedure was higher than the baseline SpO(2) in the HFNO group. Hypoxemia occurred only in the control group (n = 7; 19%; P = 0.01). Procedural interruptions, including discontinuation of sedation, patient stimulation, and jaw thrusting, occurred only in the control group (n = 9 [25%], n = 10 [28%], and n = 10 [28%] cases, respectively; P = 0.001 for each).Conclusion In contrast to conventional nasal cannula, high flow nasal oxygen provided adequate oxygenation without causing procedural interruptions during ERCP, suggesting that HFNO may be used as a standard oxygen delivery method during these procedures.