Effects of positive end-expiratory pressure and oxygen concentration on non-hypoxemic apnea time during face mask ventilation of anesthesia induction: A randomized controlled trial.
Effects of positive end-expiratory pressure and oxygen concentration on non-hypoxemic apnea time during face mask ventilation of anesthesia induction: A randomized controlled trial.
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麻醉诱导面罩通气期间呼气末正压和氧浓度对非低氧性呼吸暂停时间的影响：一项随机对照试验
DOI：
10.3389/fphys.2022.1090612
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发表时间：
2022
影响因子：
4
通讯作者：
Zhang, Changsheng
中科院分区：
文献类型：
--
作者：
Hao, Chunxiang;Ma, Xiaojing;Piao, Xiangmei;Fu, Yunke;Ma, Libin;Mi, Weidong;Berra, Lorenzo;Li, Changtian;Zhang, Changsheng
关键词：
背景：麻醉诱导时面罩通气的最佳通气策略尚不清楚。方法：我们评估两种呼气末正压（PEEP）水平（0 cmH2O和6 cmH2O）和两种氧浓度水平（1.0和1.0 cmH2O）的效果。6)麻醉诱导面罩通气时非低氧性呼吸暂停时间的影响。60名计划择期手术的成年患者被纳入本研究。在容量控制通气条件下，患者随机接受4种不同通气策略的麻醉诱导。LOZP组患者吸气O2分数低（FiO2 = 0.6）， PEEP为0。LOHP组患者接受低吸气O2分数（FiO2 = .6）和6 cmH2O PEEP。HOZP组患者吸气O2分数高（FiO2 = 1.0）， PEEP为0。HOHP组患者接受高吸气O2分数（FiO2 = 1.0）和6cmH2O PEEP。通气3分钟后，插管但断开呼吸回路。直到脉搏血氧饱和度降至90%才开始通气。主要终点是非低氧性呼吸暂停时间，定义为从停止通气到脉搏血氧计读数为90%的时间。次要指标为通气后立即的PaO2/FiO2比率。结果：与其他3组相比，HOHP组非低氧性呼吸暂停时间（LOZP、LOHP、HOZP、HOHP组分别为192 s±70 s、221 s±74 s、284 s±101 s、353 s±85 s）显著延长。LOHP组通气后立即PaO2/FiO2比值显著高于其他3组（LOHP 393±130、LOHP 496±97、HOHP 335±58、HOHP 391±50）。将通气后立即的PaO2/FiO2与麻醉前的PaO2/FiO2比值进行比较，LOHP组的PaO2/FiO2比值有所提高，LOZP组和HOHP组保持不变，HOZP组的PaO2/FiO2比值明显降低。结论：面罩通气诱导时应用PEEP和100%供氧可最大限度延长非低氧性呼吸暂停时间。然而，在预充氧过程中使用PEEP和60%的氧气可改善PaO2/FiO2比率。
Background: The optimal ventilatory strategy for the face mask ventilation during anesthesia induction is still unknow. Methods: We evaluated the effect of two positive end-expiratory pressure (PEEP) levels (0 cmH2O and 6 cmH2O) and two oxygen concentration levels (1.0 and .6) on non-hypoxemic apnea time during face mask ventilation of anesthesia induction. Sixty adult patients scheduled for elective surgery were enrolled in this study. The patients were randomized to receive anesthesia induction with four different ventilation strategy under volume-controlled ventilation. Patients assigned to the LOZP group received low fraction of inspiration O2 (FiO2 = .6) and 0 PEEP. Patients assigned to the LOHP group received low fraction of inspiration O2 (FiO2 = .6) and 6 cmH2O PEEP. Patients assigned to the HOZP group received high fraction of inspiration O2 (FiO2 = 1.0) and 0 PEEP. Patients assigned to the HOHP group received high fraction of inspiration O2 (FiO2 = 1.0) and 6cmH2O PEEP. After 3 min of ventilation, the patient was intubated but disconnected from the breathing circuit. Ventilation was not initiated until the pulse oximetry dropped to 90%. The primary outcome was non-hypoxemic apnea time defined as the time from cessation of ventilation to a pulse oximeter reading of 90%. The secondary outcome was the PaO2/FiO2 ratio immediately after ventilation. Results: The non-hypoxemic apnea time was significantly longer in the group of HOHP when compared to the other three groups (192 s ± 70 s, 221 s ± 74 s, 284 s ± 101 s, and 353 s ± 85 s in the LOZP, LOHP, HOZP, and HOHP group, respectively). The PaO2/FiO2 ratio immediately after ventilation was significantly higher in the group of LOHP when compared to the other three groups (LOZP 393 ± 130, LOHP 496 ± 97, HOZP 335 ± 58, HOHP 391 ± 50). When compared the PaO2/FiO2 ratio immediately after ventilation to its value before administration of anesthesia, the PaO2/FiO2 ratio in the group of LOHP was improved, the group LOZP and HOHP remained the same, while the group HOZP significantly decreased. Conclusion: Application of PEEP and 100% of oxygen during face mask ventilation of induction could maximize the non-hypoxemic apnea time. However, the use of PEEP and 60% of oxygen during preoxygenation resulted in improved PaO2/FiO2 ratio.
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影响因子：
5.7
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