PDF(Pubmed)
Abstract：
UNASSIGNED: Apnoeic oxygenation, although useful during elective intubations, has not shown consistent beneficial results during emergency intubations in critically ill patients. We aimed to study the effectiveness of adding apnoeic oxygenation to our routine practice of using facemask alone, in emergency laparotomy patients needing rapid sequence induction (RSI), for sustaining partial pressure of oxygen (PaO2).
UNASSIGNED: Seventy-two patients undergoing RSI for emergency laparotomy were randomly allocated to either receive pre-oxygenation with 5 L/min of oxygen (O2) with a facemask (Group-FM) or apnoeic oxygenation with 10 L/min of O2 through a nasal catheter in addition to pre-oxygenation (Group-NC). Apnoea (90 s) was allowed from the removal of the facemask before the resumption of ventilation. Arterial blood gas analysis was done at the baseline, following pre-oxygenation and after 90 s of apnoea to study the PaO2 and partial pressure of carbon dioxide (PaCO2). The circuit O2 concentrations (fraction of inspired [FiO2] and end-tidal [EtO2]) were also noted to ensure a steady state of O2 uptake was reached.
UNASSIGNED: The circuit O2 concentrations were 90 ± 4% in group FM and 93 ± 5% in Group-NC. The FiO2-EtO2 difference was 4% in both groups. During the 90 s apnoea following pre-oxygenation, there was a fall in the PaO2 by 38% in Group-FM and 12% in Group-NC (P = 0.000). Increase in PaCO2 was similar in both groups (Group-FM: 44 [range: 32-55] mmHg; Group-NC: 42 [range: 33-54] mmHg, P = 0.809).
UNASSIGNED: Apnoeic insufflation of O2 using a nasopharyngeal catheter along with facemask oxygenation is more effective in sustaining PaO2 for 90 s during RSI than facemask-only oxygenation in patients undergoing emergency laparotomy.
UNASSIGNED: Seventy-two patients undergoing RSI for emergency laparotomy were randomly allocated to either receive pre-oxygenation with 5 L/min of oxygen (O2) with a facemask (Group-FM) or apnoeic oxygenation with 10 L/min of O2 through a nasal catheter in addition to pre-oxygenation (Group-NC). Apnoea (90 s) was allowed from the removal of the facemask before the resumption of ventilation. Arterial blood gas analysis was done at the baseline, following pre-oxygenation and after 90 s of apnoea to study the PaO2 and partial pressure of carbon dioxide (PaCO2). The circuit O2 concentrations (fraction of inspired [FiO2] and end-tidal [EtO2]) were also noted to ensure a steady state of O2 uptake was reached.
UNASSIGNED: The circuit O2 concentrations were 90 ± 4% in group FM and 93 ± 5% in Group-NC. The FiO2-EtO2 difference was 4% in both groups. During the 90 s apnoea following pre-oxygenation, there was a fall in the PaO2 by 38% in Group-FM and 12% in Group-NC (P = 0.000). Increase in PaCO2 was similar in both groups (Group-FM: 44 [range: 32-55] mmHg; Group-NC: 42 [range: 33-54] mmHg, P = 0.809).
UNASSIGNED: Apnoeic insufflation of O2 using a nasopharyngeal catheter along with facemask oxygenation is more effective in sustaining PaO2 for 90 s during RSI than facemask-only oxygenation in patients undergoing emergency laparotomy.
摘要：
■呼吸暂停氧合，虽然在选择性插管期间有用，在危重患者的紧急插管期间未显示一致的有益结果。我们的目的是研究在我们单独使用面罩的常规实践中加入窒息氧合的有效性，在需要快速序列诱导（RSI）的急诊剖腹手术患者中，用于维持氧分压（PaO2）。
■72例接受RSI急诊剖腹手术的患者被随机分配到使用面罩以5L/min的氧气（O2）进行预充氧（组FM）或除预充氧（组NC）外，通过鼻导管以10L/min的O2进行呼吸氧合。在恢复通气之前，允许从面罩的移除中去除呼吸暂停（90s）。在基线时进行动脉血气分析，在预充氧和90s呼吸暂停后，研究PaO2和二氧化碳分压（PaCO2）。还注意到回路O2浓度（吸入[FiO2]和潮气末[EtO2]的分数），以确保达到O2吸收的稳态。
■电路O2浓度在FM组为90±4%，在NC组为93±5%。两组的FiO2-EtO2差异为4%。在预充氧后的90年代呼吸暂停期间，FM组和NC组PaO2分别下降38%和12%(P=0.000).两组的PaCO2增加相似（FM组：44[范围：32-55]mmHg；NC组：42[范围：33-54]mmHg，P=0.809）。
■在接受紧急剖腹手术的患者中，在RSI期间，使用鼻咽导管和面罩氧合对O2的窒息性吹入比单纯面罩氧合更有效。
■72例接受RSI急诊剖腹手术的患者被随机分配到使用面罩以5L/min的氧气（O2）进行预充氧（组FM）或除预充氧（组NC）外，通过鼻导管以10L/min的O2进行呼吸氧合。在恢复通气之前，允许从面罩的移除中去除呼吸暂停（90s）。在基线时进行动脉血气分析，在预充氧和90s呼吸暂停后，研究PaO2和二氧化碳分压（PaCO2）。还注意到回路O2浓度（吸入[FiO2]和潮气末[EtO2]的分数），以确保达到O2吸收的稳态。
■电路O2浓度在FM组为90±4%，在NC组为93±5%。两组的FiO2-EtO2差异为4%。在预充氧后的90年代呼吸暂停期间，FM组和NC组PaO2分别下降38%和12%(P=0.000).两组的PaCO2增加相似（FM组：44[范围：32-55]mmHg；NC组：42[范围：33-54]mmHg，P=0.809）。
■在接受紧急剖腹手术的患者中，在RSI期间，使用鼻咽导管和面罩氧合对O2的窒息性吹入比单纯面罩氧合更有效。
