目的:缺氧是急诊科(ED)插管过程中经常报告的并发症,可能会导致不良结局。因此,氧合在急诊气道管理中起着重要作用。已经研究了在ED中使用高流量鼻插管(HFNC)进行氧合的功效,虽然证据有限。研究目的是比较在ED中接受快速顺序插管(RSI)的患者的两种预氧合方法:(1)HFNC和(2)袋阀面罩(BVM)氧合。
方法:这是一个单中心,prospective,需要RSI的成年ED患者的随机对照试验(RCT)。患者随机接受HFNC或BVM预氧合。虽然在插管过程中继续进行HFNC治疗,喉镜检查中断BVM氧合。主要结果是插管期间的最低外周血氧饱和度(SpO2)水平。次要结果是整个手术过程中的去饱和(SpO2<90%)和严重低氧血症(SpO2<80%)的发生率。插管时间,失败的插管率,和30天生存率。
结果:共有135例患者被随机分为两组(HFNCn=68;BVMn=67)。气管插管期间测得的最低SpO2值中位数在HFNC组为96%(88.8%-99.0%),在BVM组为92%(86.0%-97.5%)(P=0.161)。在插管过程中,在HFNC组中13.2%(n=9)的患者和BVM组中8.9%(n=6)的患者发生严重低氧血症,而BVM组的35.8%(n=24)和HFNC组的26.5%(n=18)观察到轻度低氧血症。然而,两组在低氧血症发展方面无统计学差异(分别为P=.429和P=.241).两组之间插管失败的发生率没有显着差异。30天死亡率在BVM组的73.1%和HFNC组的57.4%中观察到,具有临界统计学差异(差异15.7;差异的95%CI:-0.4至30.7;P=.054)。
结论:使用HFNC进行预充氧,与BVM氧合的标准护理相比,插管期间的最低SpO2水平没有提高。此外,在插管期间使用HFNC并不能降低严重低氧血症的发生率.然而,与BVM组相比,HFNC组的30日生存率略好.
OBJECTIVE: Hypoxia is a frequently reported complication during the intubation procedure in the emergency department (ED) and may cause bad outcomes. Therefore, oxygenation plays an important role in emergency airway management. The efficacy of oxygenation with high-flow nasal cannula (HFNC) in the ED has been studied, though the evidence is limited. The study aim was to compare two methods of
preoxygenation in patients undergoing rapid sequence intubation (RSI) in the ED: (1) HFNC and (2) bag-valve mask (BVM) oxygenation.
METHODS: This is a single-center, prospective, randomized controlled trial (RCT) in adult ED patients requiring RSI. Patients were randomized to receive
preoxygenation with either HFNC or BVM. While HFNC therapy was continued during the intubation procedure, BVM oxygenation was interrupted for laryngoscopy. The primary outcome was the lowest peripheral oxygen saturation (SpO2) level during intubation. Secondary outcomes were incidence of desaturation (SpO2<90%) and severe hypoxemia (SpO2<80%) throughout the procedure, intubation time, rate of failed intubation, and 30-day survival rates.
RESULTS: A total of 135 patients were randomized into two groups (HFNC n = 68; BVM n = 67). The median lowest SpO2 value measured during intubation was 96% (88.8%-99.0%) in the HFNC group and 92% (86.0%-97.5%) in the BVM group (P = .161). During the intubation procedure, severe hypoxemia occurred in 13.2% (n = 9) of patients in the HFNC group and 8.9% (n = 6) in the BVM group, while mild hypoxemia was observed in 35.8% (n = 24) of the BVM group and 26.5% (n = 18) of the HFNC group. However, there was no statistically significant difference between the groups in terms of hypoxemia development (P = .429 and P = .241, respectively). No significant difference was reported in the rate of failed intubation between the groups. Thirty-day mortality was observed in 73.1% of the BVM group and 57.4% of the HFNC group, with a borderline statistically significant difference (difference 15.7; 95% CI of the difference: -0.4 to 30.7; P = .054).
CONCLUSIONS: The use of HFNC for
preoxygenation, when compared to standard care with BVM oxygenation, did not improve the lowest SpO2 levels during intubation. Also, the use of HFNC during intubation did not provide benefits in reducing the incidence of severe hypoxemia. However, the 30-day survival rates were slightly better in the HFNC group compared to the BVM group.