Abstract：
Obesity is a risk factor for airway-related incidents during anaesthesia. High-flow nasal oxygen has been advocated to improve safety in high-risk groups, but its effectiveness in the obese population is uncertain. This study compared the effect of high-flow nasal oxygen and low-flow facemask oxygen delivery on duration of apnoea in morbidly obese patients.
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.
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.
摘要：
背景：肥胖是麻醉期间气道相关事件的危险因素。高流量鼻腔吸氧一直被提倡提高高危人群的安全性,但其在肥胖人群中的有效性尚不确定。这项研究比较了高流量鼻氧和低流量面罩氧输送对病态肥胖患者呼吸暂停持续时间的影响。
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。
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。
