清醒纤支镜引导气管插管中氧气吹入相较负压吸引清除术中分泌物的安全性和便捷性

以下文章来源于小麻哥的日常 ，作者两只小绵羊

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摘要译文 （供参考）

清醒纤支镜引导气管插管中氧气吹入相较负压吸引清除术中分泌物的安全性和便捷性

背景与目的：

清醒状态下纤维支气管镜引导气管插管(awake fiberoptic intubation，AFOI)时，清除分泌物通常采用负压吸引。

本研究的目的是评估在AFOI过程中使用氧气吹入相较负压吸引清除视野中的分泌物的安全性，评估指标包括低饱和度（<95%）发生率、插管难易程度和完成气管插管所需的时间。

材料和方法：

本前瞻性随机研究在40名需要AFOI的成年困难气道患者中进行。

所有患者均予右美托咪定0.5mcg/kg静滴，气道实施表麻。

在纤支镜引导气管插管过程中S组行负压吸引，O组将氧气连接至纤支镜的吸引口以清除分泌物。

插管容易程度分为容易、中度和困难。

结果：

与O组(60%vs.10%)相比，S组低饱和度<95%的发生率和需要补充氧气的发生率显著较高。

插管容易的发生率(80%vs.75%)和插管时间(50.1±16.6vs.53.8±21.0s)相当。

s组的吸痰次数(中位数)显著高于O组[3(1-6)vs.2(0-5)，P0.033]。

在纤支镜引导气管插管期间，O组中氧饱和度低于95%发生率显著低于S组(10%vs.60%，P=0.002)。

结论：

在AFOI期间使用氧气吹入清除视野中的分泌物是一种比负压吸引更安全的替代方法，因为该技术在不影响插管的便捷性、尝试次数、时间或患者舒适度的情况下减少了插管过程中的氧饱和度下降的风险。

关键词：光纤；吹气；插管；吸氧；抽吸。

Safety and ease of awake fiberoptic intubation with use of oxygen insufflation versus suction to clear secretions during procedure

Background and aims: 

During awake fiberoptic intubation (AFOI), clearing secretions is usually done by suctioning. 

The study objectives were to assess the safety of AFOI with the use of oxygen insufflation versus suction to clear secretions from the field of vision during the procedure as assessed by incidence of desaturation <95%, ease of intubation, and time taken to secure the airway.

Material and methods: 

This prospective randomized study was conducted in 40 adult patients with difficult airways requiring AFOI. 

All patients received dexmedetomidine 0.5mcg/kg intravenously, and the airway was topicalized. 

In Group-S suction and in Group-O oxygen was connected to the suction port of the bronchoscope to clear the secretions by activating the suction knob during bronchoscopy. Ease of intubation was scored as easy, moderate, and hard.

Results: 

Incidence of desaturation to <95% and the need for oxygen supplementation were significantly high in Group S compared to Group O (60% vs. 10%). 

Incidence of easy intubation (80% vs. 75%) and time taken to intubate (50.1 ± 16.6 vs. 53.8 ± 21.0 s) were comparable. 

The number of times (median) suctioning was done in Group S was significantly high compared to the number of oxygen insufflations required in Group O [3 (1-6) vs. 2 (0-5), P 0.033].

Desaturation to <95% was significantly low in Group O compared to Group S during bronchoscopy (10% vs. 60%, P 0.002).

Conclusion: 

The use of oxygen insufflation to clear secretions from the field of vision during AFOI is a safer alternative to suctioning as this technique reduces the chance of desaturation during the procedure without affecting ease of intubation, number of attempts, time taken for it, or patient comfort.

Keywords: 

Fiberoptic; insufflation; intubation; oxygen; suction.

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本公众平台所刊载原创或转载内容不代表米勒之声的观点或立场。文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：MiLu.米鹭

校对：Michel.米萱  

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