背景:喉镜气管插管期间通过呼吸暂停氧合补充氧气旨在延长安全的呼吸暂停时间,降低低氧血症的风险,提高全麻首次气管插管成功率。这项系统评价了儿童气管插管期间呼吸暂停氧合的疗效和有效性。
方法:本系统综述和荟萃分析包括针对需要气管插管的儿科患者的随机对照试验和非随机研究,与无呼吸氧合的患者相比,通过任何方法评估呼吸氧合。搜索的数据库是MEDLINE,Embase,科克伦图书馆,CINAHL,ClinicalTrials.gov,国际临床试验注册平台(ICTRP)Scopus,和WebofScience从成立到2023年3月22日。数据提取和偏差风险评估遵循建议评估的分级,发展,和评估(等级)建议。
结果:在初步选择40708篇文章之后,纳入了15项总结9802名儿童的研究(10项随机对照试验,四个pre-post研究,一项前瞻性观察性研究)发表于1988年至2023年之间。纳入8项随机对照试验进行荟萃分析(n=1070名儿童;803名来自手术室,267来自新生儿重症监护病房)。无呼吸氧合增加了插管首过成功率,没有生理不稳定性(风险比[RR]1.27,95%置信区间[CI]1.03-1.57,P=0.04,I2=0),插管期间较高的氧饱和度(平均差3.6%,95%CI0.8-6.5%,P=0.02,I2=63%),与没有补充氧气相比,低氧血症的发生率降低(RR0.24,95%CI0.17-0.33,P<0.01,I2=51%)。
结论:这项系统评价与荟萃分析证实,儿童气管插管期间的呼吸氧合显著提高了首过插管成功率。此外,呼吸暂停氧合通过将氧饱和度维持在正常范围内来实现稳定的生理状况。
背景:协议于2022年12月2日在PROSPERO(注册号:CRD42022360000)上前瞻性注册。
BACKGROUND: Supplemental oxygen administration by apnoeic oxygenation during laryngoscopy for tracheal intubation is intended to prolong safe
apnoea time, reduce the risk of hypoxaemia, and increase the success rate of first-attempt tracheal intubation under general anaesthesia. This systematic
review examined the efficacy and effectiveness of apnoeic oxygenation during tracheal intubation in children.
METHODS: This systematic
review and meta-analysis included randomised controlled trials and non-randomised studies in paediatric patients requiring tracheal intubation, evaluating apnoeic oxygenation by any method compared with patients without apnoeic oxygenation. Searched databases were MEDLINE, Embase, Cochrane Library, CINAHL, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), Scopus, and Web of Science from inception to March 22, 2023. Data extraction and risk of bias assessment followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) recommendation.
RESULTS: After initial selection of 40 708 articles, 15 studies summarising 9802 children were included (10 randomised controlled trials, four pre-post studies, one prospective observational study) published between 1988 and 2023. Eight randomised controlled trials were included for meta-analysis (n=1070 children; 803 from operating theatres, 267 from neonatal intensive care units). Apnoeic oxygenation increased intubation first-pass success with no physiological instability (risk ratio [RR] 1.27, 95% confidence interval [CI] 1.03-1.57, P=0.04, I2=0), higher oxygen saturation during intubation (mean difference 3.6%, 95% CI 0.8-6.5%, P=0.02, I2=63%), and decreased incidence of hypoxaemia (RR 0.24, 95% CI 0.17-0.33, P<0.01, I2=51%) compared with no supplementary oxygen administration.
CONCLUSIONS: This systematic
review with meta-analysis confirms that apnoeic oxygenation during tracheal intubation of children significantly increases first-pass intubation success rate. Furthermore, apnoeic oxygenation enables stable physiological conditions by maintaining oxygen saturation within the normal range.
BACKGROUND: Protocol registered prospectively on PROSPERO (registration number: CRD42022369000) on December 2, 2022.