目的:低氧血症是胃肠镜检查过程中观察到的最常见的不良事件。最佳氧疗仍未最终确定。
方法:随机临床试验的系统评价和网络荟萃分析。
方法:消化内镜中心。
方法:成人(≥18岁,男女)在胃肠镜检查过程中在程序镇静下进行。
方法:发布,MEDLINE,WebofScience,Embase,和临床试验。一直搜索到2023年6月30日。随机临床试验(RCT)将任何氧疗与另一种氧疗或安慰剂(鼻插管,NC)包括在内。
方法:主要结果是低氧血症的发生率,定义为脉搏氧饱和度(SpO2)。进行随机效应网络荟萃分析。数据报告为优势比(OR),预测区间(PrI)和95%CI。根据Cochrane合作组织概述的指南评估偏差风险。通过建议分级评估来评估证据质量,发展和评价(等级)框架。
结果:我们纳入了27个RCTs,共7552例患者。与使用NC相比,无创正压通气(NIPPV)在缓解低氧血症方面表现出优异的疗效(NIPPV与NC,OR=0.16,95%CI:0.08-0.31,95%PrI:0.06-0.41),其次是Wei鼻喷射管(WNJT)(WNJTvs.NC,OR=0.17,95%CI:0.10-0.30,95%PrI:0.07-0.42)。预防低氧血症的疗效排序如下:NIPPV>WNJT>口咽/鼻咽导管>高流量鼻氧合>鼻罩>NC。
结论:在胃肠镜检查过程中,所有其他高级氧疗均比鼻插管更有效.NIPPV和WNJT似乎是预防低氧血症最有效的氧疗。此外,临床医生应根据风险人群选择最合适的氧疗,内窥镜检查的类型和不良事件。
OBJECTIVE: Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined.
METHODS: A systematic
review and network meta-analysis of randomized clinical trials.
METHODS: Digestive Endoscopy Center.
METHODS: Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation.
METHODS: Pubmed, MEDLINE, Web of Science, Embase, and Clinicaltrials.gov. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included.
METHODS: The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO2). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS: We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV vs. NC, OR = 0.16, 95% CI: 0.08-0.31, 95% PrI: 0.06-0.41), followed by Wei nasal jet tube (WNJT) (WNJT vs. NC, OR = 0.17, 95% CI: 0.10-0.30, 95% PrI: 0.07-0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC.
CONCLUSIONS: During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.