胃肠内窥镜检查(GIE)是临床实践中的主要诊断和治疗程序。低氧血症是内窥镜医师的主要并发症。新兴证据支持使用高流量鼻插管(HFNC)而不是传统鼻插管(CNC)来避免低氧血症。我们的目的是通过随机对照试验(RCTs)比较接受HFNC和CNC补充氧气的GIE患者的低氧血症风险。
我们在医学数据库PubMed中搜索,EMBASE和Cochrane确定调查上述关联的RCT。评估注册研究的偏倚风险,并将其插入随机效应模型进行荟萃分析;还评估了亚组分析和发表偏倚。
在271篇文章中,5项随机对照试验符合资格(患者n=2656,HFNC1299和CNC1357).显示HFNC患者低氧血症的相对风险(RR)显着降低(RR=0.18,CI95%:0.05-0.61),而具有高异质性(I2:79.94%,p<0.01)。接受上GIE伴HFNC的患者显示出显著较低的低氧血症风险(96%,p<0.001,I2:15.59%),即使在排除内镜逆行胰胆管造影术后(RR:0.03,CI95%:0.01-0.21),尽管具有更高的异质性(I2:41.82%)。.
接受HFNC的上GIE患者的低氧血症负担明显低于CNC患者。进一步的研究是必要的目标在内窥镜检查期间的最佳安全性。缩写:ASA,美国麻醉师学会;ASGE,美国胃肠内窥镜学会;BMI,身体质量指数;CI,置信区间;CNC,常规鼻插管;ERCP,内镜逆行胰胆管造影术;FiO2,吸气O2分数;GI,胃肠;GIE,胃肠内镜;HFNC,高流量鼻插管;ICU,重症监护病房;PEEP,呼气末正压;PRISMA,系统评价和荟萃分析的首选报告项目;RCT,随机对照试验;RR,相对风险(或风险比)。
Gastrointestinal endoscopy (GIE) represents a mainstay diagnostic and therapeutic procedure in clinical practice. Hypoxemia constitutes a major complication for endoscopists. Emerging evidence supports the utilization of high-flow nasal cannula (HFNC) over conventional nasal cannula (CNC) for avoidance of hypoxemia. Our aim was to compare the hypoxemia risk in patients undergoing GIE with HFNC versus CNC oxygen supplementation recruited by randomized controlled trials (RCTs).
We searched in medical databases PubMed, EMBASE and Cochrane to identify RCTs investigating the abovementioned association. Enrolled studies were evaluated for risk of bias and inserted into a random effects model for meta-analysis; subgroup analyses and publication bias were also assessed.
Out of 271 articles, five RCTs were eligible (patients n=2656, HFNC 1299 and CNC 1357). A statistically significant reduced relative risk (RR) of hypoxemia among HFNC patients was revealed (RR=0.18, CI95%: 0.05-0.61), whilst with high heterogeneity (I2:79.94%, p<0.01). Patients undergoing upper GIE with HFNC displayed a significantly lower hypoxemia risk (96%, p<0.001, I2:15.59%), even after exclusion of endoscopic retrograde cholangiopancreatography cases (RR:0.03, CI95%:0.01-0.21), albeit with higher heterogeneity (I2:41.82%). .
Patients undergoing upper GIE with HFNC experience significantly less hypoxemia burden than CNC counterparts. Further research is warranted to target optimal safety during endoscopy.Abbreviations: ASA, American Society of Anesthesiologists; ASGE, American Society for Gastrointestinal Endoscopy; BMI, Body Mass Index; CI, confidence interval; CNC, conventional nasal cannula; ERCP, endoscopic retrograde cholangiopancreatography; FiO2, fraction of inspired O2; GI, gastrointestinal; GIE, gastrointestinal endoscopies; HFNC, High-Flow nasal cannula; ICU, intensive care unit; PEEP, positive end-expiratory pressure; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analysis; RCTs, randomized control trials; RR, relative risk (or risk ratio).