A Nasal High-Flow System Prevents Upper Airway Obstruction and Hypoxia in Pediatric Dental Patients Under Intravenous Sedation
A Nasal High-Flow System Prevents Upper Airway Obstruction and Hypoxia in Pediatric Dental Patients Under Intravenous Sedation
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DOI：
10.1016/j.joms.2020.10.018
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发表时间：
2021-02-26
影响因子：
1.9
通讯作者：
Watanabe, Seiji
中科院分区：
文献类型：
--
作者：
Sago, Teppei;Watanabe, Koji;Watanabe, Seiji
目的：上呼吸道阻塞(UAO)和氧减饱和是儿童牙科患者静脉镇静(IVS)主要并发症的危险因素。本研究旨在探讨鼻腔高流量(NHF)系统预防小儿牙科患者静脉输液中UAO和氧减饱和的效果。30名儿童患者(年龄3-12岁)，计划在IVS下进行牙科治疗，纳入本研究。将受试者随机分为2组：经鼻插管吸氧至5 L/min(NC组)和经高频吸氧2 kg/L/min(最高可达30 L/min)(NHF组)。预测变量为流速。主要结果变量是治疗过程中是否需要干预，次要结果变量是手术过程中最低的外周毛细血管血氧饱和值。测量的其他研究变量包括患者的年龄、性别、体重、身高和手术时间。结果：NC组(n=15，平均年龄6.2+/-2.3)和NHF组(n=15，平均年龄5.9+/-2.5)男女之比为2：1。使用NHF系统后，患者的最低外周血氧饱和度明显改善(P<；0.05)。NC组(n=10)和NHF组(n=3)均需提升颌骨，以缓解UAO和促进自主呼吸(P<；0.05)。NHF组在治疗过程中的干预需求明显低于NHF组(P<；0.05)。结论：本研究结果表明，NHF系统的使用可以预防UAO的发生，改善IVS下儿童牙科患者的呼吸状况。(C)2020年美国口腔颌面外科医生协会
Purpose: Upper airway obstruction (UAO) and oxygen desaturation are risk factors for major complications of intravenous sedation (IVS) in pediatric dental patients. This study aimed to investigate the use of a nasal high-flow (NHF) system for the prevention of UAO and oxygen desaturation in pediatric dental patients under IVS.Methods: The authors implemented a prospective randomized design. Thirty pediatric patients (aged 3 to 12), scheduled for dental treatment under IVS, were enrolled in this study. The subjects were randomly assigned to 1 of 2 groups: patients who received oxygen at 5 L/minute through a nasal cannula (NC group) and patients who received oxygen at 2 kg/L/minute, up to a maximum of 30 L/minute, through the NHF system (NHF group). The predictor variable was flow rate. The primary outcome variable was the need for intervention during treatment, and the secondary outcome variable was the lowest peripheral capillary oxygen saturation values during the procedure. Additional study variables measured included patient age, gender, weight, height, and surgical duration. The Mann-Whitney U test and Fisher exact test were used for statistical analysis, with P < .05 considered as significant.Results: Both the NC (n = 15; mean age, 6.2 +/- 2.3) and NHF (n = 15; mean age, 5.9 +/- 2.5) groups had a male:female ratio of 2:1. The use of the NHF system significantly improved the lowest peripheral capillary oxygen saturation values during treatment (P < .05). Jaw lifting, to relieve UAO and facilitate spontaneous breathing, was required in both the NC (n = 10) and NHF (n = 3) groups (P < .05). The need for interventions during treatment was significantly lower in the NHF group (P < .05).Conclusions: The results of this study suggest that the use of the NHF system can prevent UAO and improve the respiratory condition of pediatric dental patients under IVS. (C) 2020 American Association of Oral and Maxillofacial Surgeons