Morbidly obese patients undergoing bariatric surgery were randomly allocated to receive either high-flow nasal (70 L min-1) or facemask (15 L min-1) oxygen. After induction of anaesthesia, the patients were apnoeic for 18 min or until peripheral oxygen saturation decreased to 92%.
Eighty patients were studied (41 High-Flow Nasal Oxygen, 39 Facemask). The median apnoea time was 18 min in both the High-Flow Nasal Oxygen (IQR 18-18 min) and the Facemask (inter-quartile range [IQR], 4.1-18 min) groups. Five patients in the High-Flow Nasal Oxygen group and 14 patients in the Facemask group desaturated to 92% within 18 min. The risk of desaturation was significantly lower in the High-Flow Nasal Oxygen group (hazard ratio=0.27; 95% confidence interval [CI], 0.11-0.65; P=0.007).
In experienced hands, apnoeic oxygenation is possible in morbidly obese patients, and oxygen desaturation did not occur for 18 min in the majority of patients, whether oxygen delivery was high-flow nasal or low-flow facemask. High-flow nasal oxygen may reduce desaturation risk compared with facemask oxygen. Desaturation risk is a more clinically relevant outcome than duration of apnoea. Individual physiological factors are likely to be the primary determinant of risk rather than method of oxygen delivery.
NCT03428256.
方法:接受减肥手术的病态肥胖患者被随机分配接受高流量鼻(70Lmin-1)或面罩(15Lmin-1)氧气。麻醉诱导后,患者呼吸暂停18分钟或直至外周血氧饱和度降至92%.
结果:研究了80例患者(41例高流量鼻氧,39Facemask)。高流量鼻氧(IQR18-18分钟)和面罩(四分位数范围[IQR],4.1-18分钟)组。高流量鼻氧组的5例患者和面罩组的14例患者在18分钟内失饱和至92%。高流量鼻氧组的去饱和风险显著降低(风险比=0.27;95%置信区间[CI],0.11-0.65;P=0.007)。
结论:在有经验的手中,病态肥胖患者可能会出现窒息氧合,大多数患者在18分钟内没有发生氧饱和度,氧气输送是高流量鼻罩还是低流量面罩。与面罩氧气相比,高流量鼻氧可以降低去饱和风险。与呼吸暂停持续时间相比,饱和度下降风险是临床上更相关的结果。个体生理因素可能是风险的主要决定因素,而不是氧气输送方法。
背景:NCT03428256。