Combination Therapy of High-flow Nasal Cannula and Upper-body Elevation for Postoperative Sleep-disordered Breathing: Randomized Crossover Trial.
Combination Therapy of High-flow Nasal Cannula and Upper-body Elevation for Postoperative Sleep-disordered Breathing: Randomized Crossover Trial.
复制标题
高流量鼻插管和上半身抬高治疗术后睡眠呼吸障碍的联合疗法：随机交叉试验。
DOI：
10.1097/aln.0000000000004254
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发表时间：
2022
期刊：
影响因子：
8.8
通讯作者：
Isono S.
中科院分区：
文献类型：
--
作者：
Sakaguchi Y;Nozaki-Taguchi N;Hasegawa M;Ishibashi K;Sato Y;Isono S.
背景：阻塞性睡眠呼吸暂停（OSA）术后患者持续气道正压治疗的接受率较低，这表明有必要开发一种替代的术后气道管理策略。作者考虑高流量鼻插管联合上肢抬高是否能改善术后OSA。方法：在某大学医院进行的一项非盲随机交叉研究，研究了在有或没有上体抬高的中重度OSA患者中，高流量鼻插管（20 l·min-1，氧浓度40%）对改良的呼吸暂停低通气指数的影响，该指数仅基于没有动脉氧饱和度标准的气流信号（基于流量的呼吸暂停低通气指数，主要结局）。术前睡眠研究分别在家中（对照组，不抬高床头）和医院（抬高床头30度）进行。在术后第一个和第二个晚上，高流量鼻插管在床头抬高或不抬高30度的情况下应用，随机分配给23名符合条件的参与者。结果23例患者中有22例（96%）接受了高流量鼻插管。四名参与者退出了这项研究。控制流为基础呼吸暂停指数(平均数±标准差,60±12 h -事件·;n = 19)降低了15 (95% CI, 6 - 30)事件与head-of-bed·h -高程(P = 0.002), 10.9(95%可信区间,1 - 21)事件·h与高速流鼻插管(P = 0.028),和23 (95% CI, 13 - 32)事件·h -结合head-of-bed高程和高速流鼻插管(P 1 (95% CI, 2至21;P = 0.022)。高流量鼻插管，单独或联合床头抬高，也改善了夜间氧合。未观察到有害事件。结论高流量鼻插管联合上肢抬高可降低OSA严重程度和夜间低氧血症，提示其可作为一种替代的术后气道管理策略。
BackgroundThe low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. The authors considered whether the combination of high-flow nasal cannula and upper-body elevation could improve postoperative OSA.MethodsThis nonblinded randomized crossover study performed at a single university hospital investigated the effect on a modified apnea hypopnea index, based exclusively on the airflow signal without arterial oxygen saturation criteria (flow-based apnea hypopnea index, primary outcome), of high-flow nasal cannula (20 l · min–1 with 40% oxygen concentration) with and without upper-body elevation in patients with moderate to severe OSA. Preoperative sleep studies were performed at home (control, no head-of-bed elevation) and in hospital (30-degree head-of-bed elevation). On the first and second postoperative nights, high-flow nasal cannula was applied with or without 30-degree head-of-bed elevation, assigned in random order to 23 eligible participants.ResultsTwenty-two of the 23 (96%) accepted high-flow nasal cannula. Four participants resigned from the study. Control flow-based apnea hypopnea index (mean ± SD, 60 ± 12 events · h–1; n = 19) was reduced by 15 (95% CI, 6 to 30) events · h–1 with head-of-bed elevation alone (P = 0.002), 10.9 (95% CI, 1 to 21) events · h–1 with high-flow nasal cannula alone (P = 0.028), and 23 (95% CI, 13 to 32) events · h–1 with combined head-of-bed elevation and high-flow nasal cannula (P –1 (95% CI, 2 to 21; P = 0.022). High-flow nasal cannula, alone or in combination with head-of-bed elevation, also improved overnight oxygenation. No harmful events were observed.ConclusionsThe combination of high-flow nasal cannula and upper-body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy.