美国维克森林大学医学院Kevin W. Gibbs研究了急诊插管时无创通气预吸氧对患者预后的影响。2024年6月13日出版的《新英格兰医学杂志》发表了这项成果。

在接受气管插管的危重成年人中，低氧血症会增加心脏骤停和死亡的风险。与氧气面罩预吸氧相比，无创通气预吸氧对气管插管期间低氧血症发生率的影响尚不确定。

在美国24个急诊科和重症监护室进行的一项多中心随机试验中，研究组随机分配接受气管插管的危重成年人（年龄≥18岁）接受无创通气或氧气面罩的预吸氧治疗。主要结局是插管期间的低氧血症，定义为在麻醉诱导至气管插管后2分钟时间间隔内氧饱和度低于85%。

在1301名入组患者中，无创通气组624名患者中有57名（9.1%）发生低氧血症，氧气面罩组637名患者（18.5%）中有118名发生（差异为-9.4个百分点；95%置信区间[CI]为-13.2至-5.6；P<0.001）。无创通气组的1名患者（0.2%）和氧气面罩组的7名患者（1.1%）发生心脏骤停（差异为-0.9个百分点；95%可信区间为-1.8至-0.1）。无创通气组有6名患者（0.9%）发生吸入，氧气面罩组有9名患者（1.4%）发生吸入（差异为-0.4个百分点；95%可信区间为-1.6至0.7）。

研究结果表明，在接受气管插管的危重成年人中，与氧气面罩预吸氧相比，无创通气预吸氧导致插管期间低氧血症的发生率较低。

附：英文原文

Title: Noninvasive Ventilation for Preoxygenation during Emergency Intubation

Author: Kevin W. Gibbs, Matthew W. Semler, Brian E. Driver, Kevin P. Seitz, Susan B. Stempek, Caleb Taylor, Daniel Resnick-Ault, Heath D. White, Sheetal Gandotra, Kevin C. Doerschug, Amira Mohamed, Matthew E. Prekker, Akram Khan, John P. Gaillard, Luke Andrea, Neil R. Aggarwal, Jason C. Brainard, LuAnn H. Barnett, Stephen J. Halliday, Veronika Blinder, Alon Dagan, Micah R. Whitson, Steven G. Schauer, James E. Walker, Jr., Andrew B. Barker, Jessica A. Palakshappa, Amelia Muhs, Joanne M. Wozniak, Patrick J. Kramer, Cori Withers, Shekhar A. Ghamande, Derek W. Russell, Andrei Schwartz, Ari Moskowitz, Sydney J. Hansen, Gopal Allada, Jordan K. Goranson, Daniel G. Fein, Peter D. Sottile, Nicholas Kelly, Shannon M. Alwood, Micah T. Long, Rishi Malhotra, Nathan I. Shapiro, David B. Page, Brit J. Long, Christopher B. Thomas, Stacy A. Trent, David R. Janz, Todd W. Rice, Wesley H. Self, Vikhyat S. Bebarta, Bradley D. Lloyd, Jillian Rhoads, Kelsey Womack, Brant Imhoff, Adit A. Ginde, Jonathan D. Casey

Issue&Volume: 2024-06-13

Abstract:

BACKGROUND

Among critically ill adults undergoing tracheal intubation, hypoxemia increases the risk of cardiac arrest and death. The effect of preoxygenation with noninvasive ventilation, as compared with preoxygenation with an oxygen mask, on the incidence of hypoxemia during tracheal intubation is uncertain.

METHODS

In a multicenter, randomized trial conducted at 24 emergency departments and intensive care units in the United States, we randomly assigned critically ill adults (age, ≥18 years) undergoing tracheal intubation to receive preoxygenation with either noninvasive ventilation or an oxygen mask. The primary outcome was hypoxemia during intubation, defined by an oxygen saturation of less than 85% during the interval between induction of anesthesia and 2 minutes after tracheal intubation.

RESULTS

Among the 1301 patients enrolled, hypoxemia occurred in 57 of 624 patients (9.1%) in the noninvasive-ventilation group and in 118 of 637 patients (18.5%) in the oxygen-mask group (difference, 9.4 percentage points; 95% confidence interval [CI], 13.2 to 5.6; P<0.001). Cardiac arrest occurred in 1 patient (0.2%) in the noninvasive-ventilation group and in 7 patients (1.1%) in the oxygen-mask group (difference, 0.9 percentage points; 95% CI, 1.8 to 0.1). Aspiration occurred in 6 patients (0.9%) in the noninvasive-ventilation group and in 9 patients (1.4%) in the oxygen-mask group (difference, 0.4 percentage points; 95% CI, 1.6 to 0.7).

CONCLUSIONS

Among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation resulted in a lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask.

DOI: 10.1056/NEJMoa2313680

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2313680