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Zhong M, Xia R, Zhou J, Zhang J, Yi X, Yang A. The comparison of preoxygenation methods before endotracheal intubation: a network meta-analysis of randomized trials. Front Med (Lausanne) 2024; 11:1379369. [PMID: 38912343 PMCID: PMC11190303 DOI: 10.3389/fmed.2024.1379369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/27/2024] [Indexed: 06/25/2024] Open
Abstract
Background Preoxygenation before endotracheal intubation (ETI) maintains asphyxiated oxygenation and reduces the risk of hypoxia-induced adverse events. Previous studies have compared various preoxygenation methods. However, network meta-analyses (NMAs) of the combined comparison of preoxygenation methods is still lacking. Methods We searched for studies published in PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Review Manager version 5.3 was used to evaluate the risk of bias. The primary outcome of this meta-analysis was low oxygen saturation (SpO2) during ETI. The secondary outcomes included SpO2 <80%, SpO2 <90%, and apnea time during ETI. NMA was performed using R 4.1.2 software gemtc packages in RStudio. Results A total of 15 randomized controlled trials were included in this study. Regarding the lowest SpO2, the noninvasive ventilation (NIV) with high-flow nasal cannula (HFNC) group performed better than the other groups. For SpO2 <80%, the NIV group (0.8603467) performed better than the HFNC (0.1373533) and conventional oxygen therapy (COT, 0.0023) groups, according to the surface under the cumulative ranking curve results. For SpO2 <90%, the NIV group (0.60932667) performed better than the HFNC (0.37888667) and COT (0.01178667) groups. With regard to apnea time, the HFNC group was superior to the COT group (mean difference: -50.05; 95% confidence interval: -90.01, -10.09; P = 0.01). Conclusion Network analysis revealed that NIV for preoxygenation achieved higher SpO2 levels than HFNC and COT and offered a more significant advantage in maintaining patient oxygenation during ETI. Patients experienced a longer apnea time after HFNC preoxygenation. The combination of NIV with HFNC proved to be significantly superior to other methods. Given the scarcity of such studies, further research is needed to evaluate its effectiveness. Systematic review registration identifier CRD42022346013.
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Affiliation(s)
- Ming Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, China
| | - Rong Xia
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Junyu Zhou
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Jing Zhang
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Xia Yi
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
| | - Anbo Yang
- Chongqing Beibei Hospital of Traditional Chinese Medicine (Chongqing Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine), Chongqing, China
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Zhang Q, Zhu L, Yuan S, Lu S, Zhang X. Identifying risk factors for hypoxemia during emergence from anesthesia in patients undergoing robot-assisted laparoscopic radical prostatectomy. J Robot Surg 2024; 18:200. [PMID: 38713381 DOI: 10.1007/s11701-024-01964-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 04/21/2024] [Indexed: 05/08/2024]
Abstract
Robot-assisted laparoscopic radical prostatectomy (RALP) has emerged as an effective treatment for prostate cancer with obvious advantages. This study aims to identify risk factors related to hypoxemia during the emergence from anesthesia in patients undergoing RALP. A cohort of 316 patients undergoing RALP was divided into two groups: the hypoxemia group (N = 134) and the non-hypoxemia group (N = 182), based on their postoperative oxygen fraction. Comprehensive data were collected from the hospital information system, including preoperative baseline parameters, intraoperative data, and postoperative recovery profiles. Risk factors were examined using multiple logistic regression analysis. The study showed that 38.9% of patients had low preoperative partial pressure of oxygen (PaO2) levels. Several clinical parameters showed significant differences between the hypoxemia group and the non-hypoxemia group, including weight (P < 0.0001), BMI (P < 0.0001), diabetes mellitus (P = 0.044), history of emphysema and pulmonary alveoli (P < 0.0001), low preoperative PaO2 (P < 0.0001), preoperative white blood cell count (P = 0.012), preoperative albumin (P = 0.048), intraoperative bleeding (P = 0.043), intraoperative CO2 accumulation (P = 0.001), duration of surgery (P = 0.046), postoperative hemoglobin level (P = 0.002), postoperative hypoxemia (P = 0.002), and early postoperative fever (P = 0.006). Multiple logistic regression analysis revealed BMI (adjusted odds ratio = 0.696, 95% confidence interval 0.612-0.719), low preoperative PaO2 (adjusted odds ratio = 9.119, 95% confidence interval 4.834-17.203), and history of emphysema and pulmonary alveoli (adjusted odds ratio = 2.804, 95% confidence interval 1.432-5.491) as independent factors significantly associated with hypoxemia on emergence from anesthesia in patients undergoing RALP. Our results demonstrate that BMI, lower preoperative PaO2, and a history of emphysema and pulmonary alveolar disease are independent risk factors associated with hypoxemia on emergence from anesthesia in patients undergoing RALP. These findings provide a theoretical framework for surgeons and anesthesiologists to facilitate strategies to mitigate postoperative hypoxemia in this unique patient population.
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Affiliation(s)
- Qiyao Zhang
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Leilei Zhu
- Department of Urology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Shengjie Yuan
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Shunmei Lu
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China
| | - Xin Zhang
- Department of Anesthesiology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, #299 Qingyang Road, Wuxi, 214023, Jiangsu Province, China.
- Department of Anesthesiology, Duke University School of Medicine, Durham, NC, 27710, USA.
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Sjöblom A, Hedberg M, Gille A, Guerra A, Aanesen V, Forsberg IM, Fagerlund MJ. Pre-oxygenation using high-flow nasal oxygen versus tight facemask in trauma patients undergoing emergency anaesthesia. Acta Anaesthesiol Scand 2024; 68:447-456. [PMID: 38129931 DOI: 10.1111/aas.14368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients suffering from major traumatic injuries frequently require emergency anaesthesia. Due to often compromised physiology and the time-sensitive management, trauma patients may be more prone to desaturate during induction of anaesthesia. We hypothesised that pre-oxygenation using high-flow nasal oxygen would decrease the risk of desaturation during induction of anaesthesia in trauma patients and the study therefore aimed to compare the frequency of desaturation when pre-oxygenation was performed with high-flow nasal oxygen or a traditional facemask. METHODS This exploratory, prospective, before-and-after study was conducted at the Karolinska University Hospital, Sweden. Adult (≥18 years of age) patients suffering major traumatic injuries needing emergency anaesthesia were included around the clock. Patients were pre-oxygenated using a tight-fitting facemask during the first nine months of enrollment. High-flow nasal oxygen was then introduced as a method for pre-oxygenation of trauma patients. The primary outcome was the proportion of patients desaturating <93% during induction of anaesthesia, assessed from the start of pre-oxygenation until one minute after intubation. Secondary outcomes included perceived difficulty of pre-oxygenation among anaesthetists (assessed on a scale between 1 and 10) and safety outcomes, such as incidence of regurgitations and intracranial gas (assessed radiologically). RESULTS Data from 96 patients were analysed. Facemask pre-oxygenation was performed in 66 patients, while 30 patients were pre-oxygenated with high-flow nasal oxygen. The most frequent trauma mechanisms were stabbing injuries (n = 34 (35%)) and fall injuries (n = 21 (22%)). There were no differences in patient characteristics between the groups. Eight (12%) versus three (10%) patients desaturated <93% in the facemask and high-flow nasal oxygen group respectively, OR 0.81 (95% CI 0.20-3.28), p = .76. Anaesthetists assessed pre-oxygenation using high-flow nasal oxygen as easier compared to facemask pre-oxygenation. No patient in any group showed signs of regurgitation. Among patients with facial or skull fractures requiring anaesthesia before radiology was performed, intracranial gas was seen in four (40%) patients pre-oxygenated with a facemask and in no patient pre-oxygenated with HFNO (p = .23). CONCLUSION In this prospective study investigating trauma patients undergoing emergency anaesthesia, we could not see any difference in the number of patients desaturating when pre-oxygenation was performed with high-flow nasal oxygen compared to a tight-fitting facemask. Pre-oxygenation using high-flow nasal oxygen was assessed as easier compared to facemask pre-oxygenation.
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Affiliation(s)
- Albin Sjöblom
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Hedberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Gille
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Andres Guerra
- Medical school, Karolinska Institutet, Stockholm, Sweden
| | - Vilde Aanesen
- Medical school, Karolinska Institutet, Stockholm, Sweden
| | - Ida-Maria Forsberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Francés R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part I. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:171-206. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factors, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine. Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - X Onrubia-Fuertes
- Department of Anesthesiology, Hospital Universitari Dr Peset, Valencia, Spain
| | - T López
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Francés
- Department of Anesthesiology. Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine. Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology. Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC), Spain
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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Fang Z, Zou D, Xiong W, Bao H, Zhao X, Chen C, Si Y, Zou J. Dynamic prediction of hypoxemia risk at different time points based on preoperative and intraoperative features: machine learning applications in outpatients undergoing esophagogastroduodenoscopy. Ann Med 2023; 55:1156-1167. [PMID: 37140918 PMCID: PMC10161946 DOI: 10.1080/07853890.2023.2187878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/01/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Hypoxemia often occurs in outpatients undergoing anesthesia-assisted esophagogastroduodenoscopy (EGD). However, there is a scarcity in tools to predict the hypoxemia risk. We aimed to solve this problem by developing and validating machine learning (ML) models based on preoperative and intraoperative features. METHODS All data were retrospectively collected from June 2021 to February 2022. The most appropriate predictive features were selected by the least absolute shrinkage and selection operator, which were incorporated and modelled by 4 ML algorithms. The area under the precision-recall curve (AUPRC) was used as the main evaluation metric to select the best models, and the selected models were compared with the STOP-BANG score. Their predictive performance was visually interpreted by SHapley Additive exPlanations. The primary endpoint of this study was hypoxemia during the procedure, defined as at least one reading of pulse oximetry < 90% without probes misplacement from the anesthesia induction beginning to the end of EGD, while the secondary endpoint was hypoxemia during induction, from the induction beginning to the start of endoscopic intubation. RESULTS Of 1160 patients in the derivation cohort, 112 patients (9.6%) developed intraoperative hypoxemia, of which 102 (8.8%) occurred during the induction period. In temporal and external validation, no matter whether based on preoperative variables or still based on preoperative plus intraoperative variables, our models showed excellent predictive performance for the two endpoints, significantly better than STOP-BANG score. In the model interpretation section, preoperative variables (airway assessment indicators, pulse oximeter oxygen saturation and BMI) and intraoperative variables (the induced propofol dose) made the highest contribution to the predictions. To our knowledge, our ML models were the first to predict hypoxemia risk, which achieved excellent overall predictive ability integrating various clinical indicators. These models have the potential to become an effective tool for adjusting sedation strategies flexibly and reducing the workload of anesthesiologists.KEY MESSAGESThis study is the first model employing ML methods based on preoperative and preoperative plus intraoperative variables for predicting the risk of hypoxemia during induction and the whole EGD procedure respectively.Our four models achieved satisfactory predictive performance and outperformed STOP-BANG score in terms of AUPRC in the temporal and external validation cohorts respectively.We found that the relevant variables of airway assessment should be fully taken into account when analyzing the risk factor of hypoxemia, and the effect of patients' age on their hypoxemia risk should be considered in conjunction with the propofol dose.
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Affiliation(s)
- Zhaojing Fang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Daizun Zou
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P.R. China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Weigen Xiong
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, P.R. China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Hongguang Bao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Xiuxiu Zhao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, P.R. China
| | - Yanna Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, P.R. China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, P.R. China
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Edmark L, Englund EK, Jonsson AS, Zilic AT, Cajander P, Östberg E. Pressure-controlled versus manual facemask ventilation for anaesthetic induction in adults: A randomised controlled non-inferiority trial. Acta Anaesthesiol Scand 2023; 67:1356-1362. [PMID: 37476919 DOI: 10.1111/aas.14308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/06/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
BACKGROUND Pressure-controlled face mask ventilation (PC-FMV) with positive end-expiratory pressure (PEEP) after apnoea following induction of general anaesthesia prolongs safe apnoea time and reduces atelectasis formation. However, depending on the set inspiratory pressure, a delayed confirmation of a patent airway might occur. We hypothesised that by lowering the peak inspiratory pressure (PIP) when using PC-FMV with PEEP, confirmation of a patent airway would not be delayed as studied by the first return of CO2 , compared with manual face mask ventilation (Manual FMV). METHODS This was a single-centre, randomised controlled non-inferiority trial. Seventy adult patients scheduled for elective day-case surgery under general anaesthesia with body mass index between 18.5 and 29.9 kg m-2 , American Society of Anesthesiologists (ASA) classes I-III, and without anticipated difficult FMV, were included. Before the start of pre-oxygenation and induction of general anaesthesia, participants were randomly allocated to receive ventilation with either PC-FMV with PEEP, at a PIP of 11 and a PEEP of 6 cmH2 O or Manual FMV, with the adjustable pressure-limiting valve set at 11 cmH2 O. The primary outcome variable was the number of ventilatory attempts needed until confirmation of a patent airway, defined as the return of at least 1.3 kPa CO2 . RESULTS The return of ≥1.3 kPa CO2 on the capnography curve was observed after mean ± SD, 3.6 ± 4.2 and 2.5 ± 1.9 ventilatory attempts/breaths with PC-FMV with PEEP and Manual FMV, respectively. The difference in means (1.1 ventilatory attempts/breaths) had a 99% CI of -1.0 to 3.1, within the accepted upper margin of four breaths for non-inferiority. CONCLUSION Following induction of general anaesthesia, PC-FMV with PEEP was used without delaying a patent airway as confirmed with capnography, if moderate pressures were used.
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Affiliation(s)
- Lennart Edmark
- Department of Anaesthesia and Intensive Care, Västmanland Hospital Köping, Köping, Sweden
- Region Västmanland-Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden
| | - Emma-Karin Englund
- Department of Anaesthesia and Intensive Care, Västmanland Hospital Köping, Köping, Sweden
| | | | | | - Per Cajander
- Department of Anaesthesia and Intensive Care, Örebro University Hospital, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Erland Östberg
- Department of Anaesthesia and Intensive Care, Västmanland Hospital Köping, Köping, Sweden
- Region Västmanland-Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden
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7
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Park JJ, Seong H, Huh H, Kwak JS, Park H, Yoon SZ, Cho JE. Comparison between pressure-controlled and manual ventilation during anesthetic induction in patients with expected difficult airway: A prospective randomized controlled trial. Medicine (Baltimore) 2023; 102:e35007. [PMID: 37653750 PMCID: PMC10470681 DOI: 10.1097/md.0000000000035007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Gastric insufflation can cause gastric regurgitation, which may be exacerbated in patients who are expected to have difficult airways. The purpose of this study was to investigate the difference in respiratory parameters and the frequency of gastric insufflation according to the ventilation mode during the anesthestic induction on patients who were predicted to have difficult facemask ventilation. METHODS A total of eighty patients with expected airway difficulties were included. Patient were allocated to 2 groups (n = 40 each). In the manual ventilation group, ventilation was performed by putting a mask on the patient's face with 1-hand and adjusting the pressure limiting valve to 15 cm H2O. In the pressure-controlled ventilation group, a mask was held in place using 2-handed jaw-thrust maneuver. The pressure-controlled ventilation was applied and peak inspiration pressure was adjusted to achieve a tidal volume of 6 to 8 mL/kg. The primary outcome was the difference of the peak airway pressure between 2 groups every 30 seconds for 120 seconds duration of mask ventilation. We also evaluated respiratory variables including peak airway pressure, End-tidal carbon dioxide and also gastric insufflation using ultrasonography. RESULTS The pressure-controlled ventilation group demonstrated lower peak airway pressure than the manual ventilation group (P = .005). End-tidal carbon dioxide was higher in the pressure-controlled ventilation group (P = .012). The incidence of gastric insufflation assessed by real-time ultrasonography of the gastric antrum was higher in the manual ventilation group than in the pressure-controlled ventilation group [3 (7.5%) vs 17 (42.5%), risk ratio (95% confidence interval): 0.06 to 0.56, P = .003]. CONCLUSIONS Pressure-controlled ventilation during facemask ventilation in patients who were expected to have difficult airways showed a lower gastric insufflation rate with low peak airway pressure compared to manual ventilation.
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Affiliation(s)
- Jeong Jun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyunyoung Seong
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hyub Huh
- Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gang Dong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Ji Soo Kwak
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Heechan Park
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seung Zhoo Yoon
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jang Eun Cho
- Department of Anesthesiology and Pain Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Vourc'h M, Huard D, Le Penndu M, Deransy R, Surbled M, Malidin M, Mahe PJ, Guitton C, Roquilly A, Malard O, Feuillet F, Rozec B, Asehnoune K. High-flow oxygen therapy versus facemask preoxygenation in anticipated difficult airway management (PREOPTI-DAM): an open-label, single-centre, randomised controlled phase 3 trial. EClinicalMedicine 2023; 60:101998. [PMID: 37251624 PMCID: PMC10220226 DOI: 10.1016/j.eclinm.2023.101998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Background Difficult airway management remains a critical procedure with life-threatening adverse events. Current guidelines suggest high-flow therapy by nasal cannulae (HFNC) as a preoxygenation device in this setting. However, there is an evidence gap to support this recommendation. Methods The PREOPTI-DAM study is an open-label, single-centre, randomised controlled phase 3 trial done at Nantes University Hospital, France. Patients were aged 18-90 years with one major or two minor criteria of anticipated difficult airway management, and requiring intubation for scheduled surgery, were eligible. Patients with body mass index >35 kg/m2 were excluded. Patients were randomly allocated (1:1) to receive 4-min preoxygenation by HFNC or facemask. Randomisation was stratified according to the intubation strategy (laryngoscopic versus fiberoptic intubation). The primary outcome was the incidence of oxygen desaturation ≤94% or of bag-mask ventilation during intubation. The primary and safety analyses included the intention to treat population. This trial is registered with ClinicalTrials.gov (NCT03604120) and EudraCT (2018-A00434-51). Findings From September 4 2018 to March 31 2021, 186 patients were enrolled and randomly assigned. One participant withdrew consent and 185 (99.5%) were included in the primary analysis (HFNC, N = 95; Facemask, N = 90). The incidence of the primary outcome was not significantly different between the HFNC and the facemask groups, respectively 2 (2%) versus 7 (8%); adjusted difference, -5.6 [95% confidence interval (CI), -11.8 to 0.6], P = 0.10. In the HFNC group, 76 patients (80%) versus 53 (59%) in the facemask group, reported good or excellent intubation experiences; adjusted difference 20.5 [95% CI, 8.3-32.8], P = 0.016. Comparing HFNC with facemask, severe complication occurred in 22 (23%) versus 27 (30%) patients (P = 0.29), and moderate complication in 14 (15%) versus 18 (20%) patients (P = 0.35). No death or cardiac arrest occurred during the study. Interpretation Compared with facemask, HFNC did not significantly reduce the incidence of desaturation ≤94% or bag-mask ventilation during anticipated difficult intubation but the trial was underpowered to rule out a clinically significant benefit. Patient satisfaction was improved with HFNC. Funding Nantes University Hospital and Fisher & Paykel Healthcare.
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Affiliation(s)
- Mickael Vourc'h
- Service d’Anesthésie Réanimation Chirurgie Cardiaque, Hôpital Laennec, CHU de Nantes, France
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
| | - Donatien Huard
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Marguerite Le Penndu
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Romain Deransy
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Marielle Surbled
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Maelle Malidin
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Pierre-Joachim Mahe
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Christophe Guitton
- Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, France
| | - Antoine Roquilly
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
| | - Olivier Malard
- Service de Chirurgie Oto-Rhino-Laryngologique (ORL) et Chirurgie Cervico-faciale, Hôtel Dieu, CHU de Nantes, France
| | - Fanny Feuillet
- INSERM, Methods in Patient-Centered Outcomes and Health Research, SPHERE, CHU de Tours, France
- Service de Pharmacie, Hôtel Dieu, CHU de Nantes, France
- Plateforme de Méthodologie et de Biostatistique, DRI CHU de Nantes, France
| | - Bertrand Rozec
- Service d’Anesthésie Réanimation Chirurgie Cardiaque, Hôpital Laennec, CHU de Nantes, France
- Institut du Thorax, Institut National de la Santé et de la Recherche Médicale (INSERM), Centre National de la Recherche Scientifique (CNRS), Université de Nantes, France
| | - Karim Asehnoune
- INSERM CIC 0004 Immunologie et Infectiologie, Université de Nantes, France
- Service d’Anesthésie Réanimation Chirurgicale, Hôtel Dieu, CHU de Nantes, France
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9
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Jaber S, De Jong A, Schaefer MS, Zhang J, Ma X, Hao X, Zhou S, Lv S, Banner-Goodspeed V, Niu X, Sfara T, Talmor D. Preoxygenation with standard facemask combining apnoeic oxygenation using high flow nasal cannula versuss standard facemask alone in patients with and without obesity: the OPTIMASK international study. Ann Intensive Care 2023; 13:26. [PMID: 37014462 PMCID: PMC10073359 DOI: 10.1186/s13613-023-01124-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/25/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Combining oxygen facemask with apnoeic oxygenation using high-flow-nasal-oxygen (HFNO) for preoxygenation in the operating room has not been studied against standard oxygen facemask alone. We hypothesized that facemask-alone would be associated with lower levels of lowest end-tidal oxygen (EtO2) within 2 min after intubation in comparison with facemask combined with HFNO. METHODS In an international prospective before-after multicentre study, we included adult patients intubated in the operating room from September 2022 to December 2022. In the before period, preoxygenation was performed with facemask-alone, which was removed during laryngoscopy. In the after period, facemask combined with HFNO was used for preoxygenation and HFNO for apnoeic oxygenation during laryngoscopy. HFNO was maintained throughout intubation. The primary outcome was the lowest EtO2 within 2 min after intubation. The secondary outcome was SpO2 ≤ 95% within 2 min after intubation. Subgroup analyses were performed in patients without and with obesity. This study was registered 10 August 2022 with ClinicalTrials.gov, number NCT05495841. RESULTS A total of 450 intubations were evaluated, 233 with facemask-alone and 217 with facemask combined with HFNO. In all patients, the lowest EtO2 within 2 min after intubation was significantly lower with facemask-alone than with facemask combined with HFNO, 89 (85-92)% vs 91 (88-93)%, respectively (mean difference - 2.20(- 3.21 to - 1.18), p < 0.001). In patients with obesity, similar results were found [87(82-91)% vs 90(88-92)%, p = 0.004]; as in patients without obesity [90(86-92)% vs 91(89-93)%, p = 0.001)]. SpO2 ≤ 95% was more frequent with facemask-alone (14/232, 6%) than with facemask combined with HFNO (2/215, 1%, p = 0.004). No severe adverse events were recorded. CONCLUSIONS Combining facemask with HFNO for preoxygenation and apnoeic oxygenation was associated with increased levels of lowest EtO2 within 2 min after intubation and less desaturation.
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Affiliation(s)
- Samir Jaber
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1; 80 avenue Augustin Fliche, Montpellier cedex 5, Montpellier, France.
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France.
| | - Audrey De Jong
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1; 80 avenue Augustin Fliche, Montpellier cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Maximilian S Schaefer
- Center for Anesthesia Research Exellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Jiaqiang Zhang
- Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Xiaowen Ma
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Xinrui Hao
- Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Shujing Zhou
- Department of Anesthesiology, Renji Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai, China
| | - Shang Lv
- Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Valerie Banner-Goodspeed
- Center for Anesthesia Research Exellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
| | - Xiuhua Niu
- Shenzhen Mindray Bio-Medical Electronics Co., Ltd. Mindray Building, Keji 12th Road South, High-tech Industrial Park, Nanshan, Shenzhen, 518057, People's Republic of China
| | - Thomas Sfara
- Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1; 80 avenue Augustin Fliche, Montpellier cedex 5, Montpellier, France
- Centre Hospitalier Universitaire Montpellier, 34295, Montpellier, France
| | - Daniel Talmor
- Center for Anesthesia Research Exellence, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
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10
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Xiong W, Zou D, Fang Z, Zhao X, Chen C, Zou J, Si Y. An interpretable artificial neural network model for predicting hypoxemia via an online tool in adult (18-64) patients during esophagogastroduodenoscopy. Digit Health 2023; 9:20552076231180522. [PMID: 37312946 PMCID: PMC10259111 DOI: 10.1177/20552076231180522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/19/2023] [Indexed: 06/15/2023] Open
Abstract
Background The hypoxemia risk in adult (18-64) patients treated with esophagogastroduodenoscopy (EGD) under sedation often poses a dilemma for anesthesiologists. We aimed to establish an artificial neural network (ANN) model to solve this problem, and introduce the Shapley additive explanations (SHAP) algorithm to further improve the interpretability. Methods The relevant data of patients underwent routine anesthesia-assisted EGD were collected. Elastic network was used to filter the optimal features. Airway-ANN and Basic-ANN models were established based on all collected indicators and remaining variables excluding airway assessment indicators, respectively. The performance of Basic-ANN, Airway-ANN and STOP-BANG was evaluated by the area under the precision-recall curve (AUPRC) on temporal validation set. The SHAP was used for revealing the predictive behavior of our best model. Results 999 patients were eventually included. The AUPRC value of Airway-ANN model was significantly higher than Basic-ANN model in the temporal validation set (0.532 vs 0.429, P < 0.05). And the performance of both two ANN models was significantly better than that of STOP-BANG score (both P < 0.05). The Airway-ANN model was deployed to the cloud (http://njfh-yxb.com.cn:2022/airway_ann). Conclusion Our online interpretable Airway-ANN model achieved satisfying ability in identifying the hypoxemia risk in adult (18-64) patients undergoing EGD.
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Affiliation(s)
- Weigen Xiong
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Daizun Zou
- School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhaojing Fang
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiuxiu Zhao
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Chen Chen
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Jianjun Zou
- Department of Clinical Pharmacology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Pharmacy, Nanjing First Hospital, China Pharmaceutical University, Nanjing, China
| | - Yanna Si
- Department of Anesthesiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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11
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Benedik J, Ogorevc B, Brezar SK, Cemazar M, Sersa G, Groselj A. Comparison of general anesthesia and continuous intravenous sedation for electrochemotherapy of head and neck skin lesions. Front Oncol 2022; 12:1011721. [PMID: 36465339 PMCID: PMC9717680 DOI: 10.3389/fonc.2022.1011721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/21/2022] [Indexed: 11/19/2022] Open
Abstract
BackgroundElectrochemotherapy of cutaneous tumor nodules requires local or general anesthesia. For multiple and larger nodules, general anesthesia is recommended by standard operating procedures. The choice of general anesthesia is at the discretion of the treating center. Continuous intravenous sedation is also an option. Our study aimed to elucidate the tolerability, safety and possible advantages of continuous intravenous sedation in comparison to general anesthesia in patients undergoing electrochemotherapy.Patients and methodsIn the prospective study, 27 patients undergoing electrochemotherapy were either under general anesthesia or under continuous intravenous sedation. Evaluated were different endpoints, such as feasibility and safety, duration of anesthesia and compliance with the patients.ResultsTen patients were treated under general anesthesia, and 17 patients were under continuous intravenous sedation. The comparison of the approaches indicated that continuous intravenous sedation required a lower overall dosage of propofol, a shorter duration of anesthesia, a shorter time to reach an Aldrete score >8, and greater satisfaction of the patients with the procedure compared to general anesthesia.ConclusionThe results indicate the feasibility and safety of continuous intravenous sedation for patients undergoing electrochemotherapy of cutaneous tumor nodules. This proved the preferred choice of anesthesia due to its shorter duration and better compliance with the patients compared to general anesthesia.
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Affiliation(s)
- Janez Benedik
- Department of Anesthesiology and Perioperative Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Barbara Ogorevc
- Department of Anesthesiology and Perioperative Intensive Care Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simona Kranjc Brezar
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Maja Cemazar
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Primorska, Izola, Slovenia
| | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
- *Correspondence: Ales Groselj, ; Gregor Sersa,
| | - Ales Groselj
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
- *Correspondence: Ales Groselj, ; Gregor Sersa,
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12
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Cai Q, Ma W, Wu C, Liu H, Wang S, Zhang G. [Is pre-oxygenation with high-flow nasal oxygen safe? randomized control trial of 56 cases of elderly patients during induction of general anesthesia with endotracheal intubation]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1069-1074. [PMID: 35869772 DOI: 10.12122/j.issn.1673-4254.2022.07.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the safety of preoxygenation with high-flow nasal oxygenation in elderly patients during induction of general anesthesia with endotracheal intubation. METHODS Fifty-six elderly patients without difficult airway were randomized equally into high-flow nasal oxygen group (HF group) and conventional mask oxygen group (M group). Preoxygenation was performed for 5 min before induction of general anesthesia and endotracheal intubation. Oxygenation was maintained during laryngoscopy in HF group, and ventilation lasted until laryngoscopy in M group. For all the patients, the general data, cross-sectional area (CSA) of the gastric antrum measured by ultrasonography, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2) and arterial oxygen saturation (cSO2) were recorded before preoxygenation (T1), at 5 min of preoxygenation (T2) and immediately after intubation (T3). The safety time of asphyxia, intubation time, times of mask ventilation and postoperative complications were compared between the two groups. RESULTS The general data were comparable between the two groups. After 5 min of preoxygenation, PaO2 and cSO2 were significantly increased in both groups, and PaO2 was significantly higher in HF group than in M group (F=118.108 vs 9.511, P < 0.05). Both PaO2 and cSO2 decreased after intubation, but PaO2 decreased more slowly in HF group and still remained higher than that at T1; cSO2 decreased significantly in M group to a lower level than that at T1. Compared with those in M group, the patients in HF group showed a significantly longer safety time of asphyxia (t=5.305, P < 0.05) with fewer times of mask ventilation (χ2= 6.720, P < 0.05). PaCO2 increased after intubation in both groups but was comparable between the two groups (F=3.138, P > 0.05). CONCLUSION High-flow nasal oxygen is safe, simple and effective for pre-oxygenation, which, as compared with the conventional oxygen mask, improves arterial oxygen partial pressure and prolongs the safety time of asphyxia to ensure the safety of airway management during induction of general anesthesia in elderly patients with endotracheal intubation.
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Affiliation(s)
- Q Cai
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - W Ma
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - C Wu
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - H Liu
- Department of Anesthesiology, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China
| | - S Wang
- First Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - G Zhang
- Department of Anesthesiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510120, China
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13
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Pulse Oximeter Performance during Rapid Desaturation. SENSORS 2022; 22:s22114236. [PMID: 35684858 PMCID: PMC9185462 DOI: 10.3390/s22114236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023]
Abstract
The reliability of pulse oximetry is crucial, especially in cases of rapid changes in body oxygenation. In order to evaluate the performance of pulse oximeters during rapidly developing short periods of concurrent hypoxemia and hypercapnia, 13 healthy volunteers underwent 3 breathing phases during outdoor experiments (39 phases in total), monitored simultaneously by five different pulse oximeters. A significant incongruity in values displayed by the tested pulse oximeters was observed, even when the accuracy declared by the manufacturers were considered. In 28.2% of breathing phases, the five used devices did not show any congruent values. The longest uninterrupted congruent period formed 74.4% of total recorded time. Moreover, the congruent periods were rarely observed during the critical desaturation phase of the experiment. The time difference between the moments when the first and the last pulse oximeter showed the typical study endpoint values of SpO2 85% and 75% was 32.1 ± 23.6 s and 24.7 ± 19.3 s, respectively. These results suggest that SpO2 might not be a reliable parameter as a study endpoint, or more importantly as a safety limit in outdoor experiments. In the design of future studies, more parameters and continuous clinical assessment should be included.
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14
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Yamamoto R, Kaito D, Homma K, Endo A, Tagami T, Suzuki M, Umetani N, Yagi M, Nashiki E, Suhara T, Nagata H, Kabata H, Fukunaga K, Yamakawa K, Hayakawa M, Ogura T, Hirayama A, Yasunaga H, Sasaki J. Early intubation and decreased in-hospital mortality in patients with coronavirus disease 2019. Crit Care 2022; 26:124. [PMID: 35524282 PMCID: PMC9073819 DOI: 10.1186/s13054-022-03995-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation. METHODS A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation. RESULTS Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission. CONCLUSIONS Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.
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Affiliation(s)
- Ryo Yamamoto
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - Daiki Kaito
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - Koichiro Homma
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa Japan
| | - Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Morio Suzuki
- Department of Emergency and Critical Care Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Naoyuki Umetani
- Department of Emergency and Critical Care Medicine, Kawakita General Hospital, Tokyo, Japan
| | - Masayuki Yagi
- Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, Chiba, Japan
| | - Eisaku Nashiki
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa Japan
| | - Tomohiro Suhara
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromasa Nagata
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiroki Kabata
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kazuma Yamakawa
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Mineji Hayakawa
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido Japan
| | - Takayuki Ogura
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan
| | - Atsushi Hirayama
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Junichi Sasaki
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
| | - the J-RECOVER study group
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582 Japan
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Nippon Medical School Musashikosugi Hospital, Kawasaki, Kanagawa Japan
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Kawakita General Hospital, Tokyo, Japan
- Emergency Medicine and Acute Care Surgery, Matsudo City General Hospital, Chiba, Japan
- Department of Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa Japan
- Department of Anesthesiology, Keio University School of Medicine, Tokyo, Japan
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Emergency Medicine, Hokkaido University Hospital, Sapporo, Hokkaido Japan
- Department of Emergency Medicine and Critical Care Medicine, Tochigi Prefectural Emergency and Critical Care Centre, Imperial Foundation Saiseikai Utsunomiya Hospital, Tochigi, Japan
- Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
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15
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Qiu J, Xie M, Chen J, Chen B, Chen Y, Zhu X, Lin H, Zhu T, Duan G, Huang H. Tracheal Extubation Under Deep Anesthesia Using Transnasal Humidified Rapid Insufflation Ventilatory Exchange vs. Awake Extubation: An Open-Labeled Randomized Controlled Trial. Front Med (Lausanne) 2022; 9:810366. [PMID: 35308520 PMCID: PMC8927763 DOI: 10.3389/fmed.2022.810366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/10/2022] [Indexed: 02/05/2023] Open
Abstract
Background Tracheal extubation can be associated with several complications, including desaturation, agitation, hypertension, and tachycardia. We hypothesize that the use of transnasal humidified rapid insufflation ventilator exchange (THRIVE) immediately after extubation under deep anesthesia reduces the incidence of these adverse events. Methods One hundred patients who underwent elective abdominal surgery under general anesthesia were randomly assigned to undergo tracheal extubation under deep anesthesia employing THRIVE (THRIVE group) or awake extubation (CONTROL group). The primary outcome was the incidence of experiencing desaturation (SpO2 < 90%) at any time during emergence from anesthesia. Secondary outcomes included variations in heart rate and blood pressure, comfort level, bucking, and agitation. Results The THRIVE group showed a lower incidence of desaturation than the CONTROL group (12 vs. 54%, OR = 0.22 [95% CI, 0.10-0.49], P < 0.001). Less patients in the THRIVE group experienced a 20% (or more) increase in mean arterial pressure (4 vs. 26%, OR = 0.15 [95% CI, 0.04-0.65], P = 0.002). THRIVE patients did not suffer from agitation or bucking, while in the CONTROL group agitation and bucking occurred in 22 and 58% of the patients, respectively. Additionally, the THRIVE group showed a lower incidence of uncomfortable experience than the CONTROL group (8 vs. 36%, OR = 0.22 [95% CI, 0.08-0.61], P = 0.001). Conclusion Tracheal extubation under deep anesthesia using THRIVE decreases the incidence of desaturation and adverse haemodynamic events and increases patient satisfaction. Extubation under deep anesthesia using THRIVE might be an alternative strategy in selected patient populations.
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Affiliation(s)
- Jin Qiu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Mian Xie
- Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Jie Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Bing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Yuanjing Chen
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xiwen Zhu
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Hui Lin
- Department of Statistics, Army Medical University, Chongqing, China
| | - Tao Zhu
- Department of Anesthesiology and Translational Neuroscience Center, West China Hospital, Sichuan University, Chengdu, China
| | - Guangyou Duan
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - He Huang
- Department of Anesthesiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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16
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Dai Y, Dai J, Walline JH, Fu Y, Zhu H, Xu J, Yu X. Can bag-valve mask ventilation with positive end-expiratory pressure reduce hypoxia during intubation? A prospective, randomized, double-blind trial. Trials 2021; 22:460. [PMID: 34274023 PMCID: PMC8285778 DOI: 10.1186/s13063-021-05413-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 06/30/2021] [Indexed: 11/25/2022] Open
Abstract
Background Hypoxia is one of the life-threatening complications of endotracheal intubation. Supplemental oxygen and ventilation play a vital role in preventing hypoxia. Bag-valve mask (BVM) ventilation is frequently used before intubation, and its ability to improve oxygenation was recently confirmed. It is still unclear if positive end-expiratory pressure (PEEP) added to BVM ventilation can further reduce hypoxia during intubation. Methods This will be a prospective, randomized, double-blind trial to determine if PEEP combined with BVM ventilation can reduce the incidence of hypoxia during intubation compared with conventional BVM ventilation. The lowest oxygen saturation and incidence of complications will be compiled to verify the comparative effectiveness and safety of the two groups. Discussion BMV ventilation with PEEP is hoped to further reduce the incidence of hypoxia during intubation. Trial registration Chinese Clinical Trial Registry ChiCTR2000035156. Registered on August 2, 2020. It had begun enrollment after passing ethical review but before registration.
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Affiliation(s)
- Yili Dai
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiayuan Dai
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, No. 30-32 Ngan Shing Street, Shatin, NT, Hong Kong, China
| | - Yangyang Fu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huadong Zhu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Xu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Xuezhong Yu
- Emergency Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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17
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Garofalo E, Bruni A, Scalzi G, Curto LS, Rovida S, Brescia V, Gervasi R, Navalesi P, Innaro N, Longhini F. Low-Dose of Rocuronium During Thyroid Surgery: Effects on Intraoperative Nerve-Monitoring and Intubation. J Surg Res 2021; 265:131-138. [PMID: 33940235 DOI: 10.1016/j.jss.2021.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraoperative Neurophysiological Monitoring (IONM) reduces the incidence of Recurrent Laryngeal Nerve (RLN) injuries during thyroid surgery. To preserve nerve function, long acting neuromuscular blocking agents (NMBA) should be avoided. However, NMBA are necessary for laryngoscopy and endotracheal intubation. We designed this double-blinded, randomized, placebo-controlled trial to assess if a low-dose of rocuronium given at intubation would affect the IONM data recorded before the thyroid dissection. METHODS Hundred patients undergoing elective thyroid surgery were randomized to receive either 0.3 mg kg-1 of low dose rocuronium (intervention) or no-NMBA (control). Intubation was performed with video-laryngoscopy. IONM was placed on RLN and nerve stimulation was performed before and after thyroid dissection. The presence of a valid amplitude prior to dissection was defined when the IONM signal was >100 μV. Occurrence of difficult laryngoscopy was reported together with intubation details including time, difficulty and failure. The lowest peripheral saturation (SpO2) and the number of desaturation episodes during the intubation were also registered. RESULTS No patients showed impaired IONM signal before dissection in both groups. Cormack-Lehane grade was higher in the intervention group (11;2) compared to control one (11;1; P = 0.046). No-NMBA patients had increased number of difficult laryngoscopies (21% versus 6%, P = 0.041) and intubations (34% versus 8%; P = 0.003) as well as a longer time to intubation (78 [55; 175] versus 55 [31; 110] sec; P = 0.006). Lower values of peripheral SpO2 during intubation attempt were registered in the no NMBA group (99 [97; 100] versus 99 [99; 100] %; P = 0.020). However, the number of intubation failure was similar between groups (p=0.495). CONCLUSIONS Low-dose of rocuronium does not compromise pre-dissection IONM signal and improves intubation condition when compared to a relaxant free strategy.
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Affiliation(s)
- Eugenio Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Giuseppe Scalzi
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Lucia Stella Curto
- Endocrine Surgery Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Serena Rovida
- Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Vincenzo Brescia
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Rita Gervasi
- Endocrine Surgery Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Padua Hospital, Department of Medicine - DIMED, University of Padua, Italy
| | - Nadia Innaro
- Endocrine Surgery Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
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18
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Obesity in pregnancy. Int Anesthesiol Clin 2021; 59:8-14. [PMID: 33883427 DOI: 10.1097/aia.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Lam SW, Irwin MG. Pre-oxygenation for rapid sequence induction: is high-flow nasal oxygenation worth the hassle? Anaesthesia 2021; 76:1159-1162. [PMID: 33783827 DOI: 10.1111/anae.15473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2021] [Indexed: 11/29/2022]
Affiliation(s)
- S W Lam
- Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
| | - M G Irwin
- Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong
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20
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Sjöblom A, Broms J, Hedberg M, Lodenius Å, Furubacke A, Henningsson R, Wiklund A, Nabecker S, Theiler L, Jonsson Fagerlund M. Pre-oxygenation using high-flow nasal oxygen vs. tight facemask during rapid sequence induction. Anaesthesia 2021; 76:1176-1183. [PMID: 33599993 DOI: 10.1111/anae.15426] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2020] [Indexed: 12/21/2022]
Abstract
Pre-oxygenation using high-flow nasal oxygen can decrease the risk of desaturation during rapid sequence induction in patients undergoing emergency surgery. Previous studies were single-centre and often in limited settings. This randomised, international, multicentre trial compared high-flow nasal oxygen with standard facemask pre-oxygenation for rapid sequence induction in emergency surgery at all hours of the day and night. A total of 350 adult patients from six centres in Sweden and one in Switzerland undergoing emergency surgery where rapid sequence induction was required were included and randomly allocated to pre-oxygenation with 100% oxygen using high-flow nasal oxygen or a standard tight-fitting facemask. The primary outcome was the number of patients developing oxygen saturations <93% from the start of pre-oxygenation until 1 min after tracheal intubation. Data from 349 of 350 patients who entered the study were analysed (174 in the high-flow nasal oxygen group and 175 in the facemask group). No difference was detected in the number of patients desaturating <93%, five (2.9%) vs. six (3.4%) patients in the high-flow nasal oxygen and facemask group, respectively (p = 0.77). The risk of desaturation was not increased during on-call hours. No difference was seen in end-tidal carbon dioxide levels in the first breath after tracheal intubation or in the number of patients with signs of regurgitation between groups. These results confirm that high-flow nasal oxygen maintains adequate oxygen levels during pre-oxygenation for rapid sequence induction.
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Affiliation(s)
- A Sjöblom
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
| | - J Broms
- South General Hospital, Stockholm, Sweden
| | - M Hedberg
- Peri-operative Medicine and Intensive Care, Karolinska University Hospital Solna, Stockholm, Sweden
| | | | - A Furubacke
- Linköping University Hospital, Linköping, Sweden
| | | | - A Wiklund
- Capio St. Göran Hospital, Stockholm, Sweden
| | - S Nabecker
- Department of Anaesthesiology and Pain Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
| | - L Theiler
- Anaesthesia Department, Kantonsspital Aarau, Aarau, Switzerland
| | - M Jonsson Fagerlund
- Peri-operative Medicine and Intensive Care, Karolinska University Hospital Solna, Solna, Sweden.,Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden
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21
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Crewdson K, Heywoth A, Rehn M, Sadek S, Lockey D. Apnoeic oxygenation for emergency anaesthesia of pre-hospital trauma patients. Scand J Trauma Resusc Emerg Med 2021; 29:10. [PMID: 33413576 PMCID: PMC7789511 DOI: 10.1186/s13049-020-00817-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Efficient and timely airway management is universally recognised as a priority for major trauma patients, a proportion of whom require emergency intubation in the pre-hospital setting. Adverse events occur more commonly in emergency airway management, and hypoxia is relatively frequent. The aim of this study was to establish whether passive apnoeic oxygenation was effective in reducing the incidence of desaturation during pre-hospital emergency anaesthesia. METHODS A prospective before-after study was performed to compare patients receiving standard care and those receiving additional oxygen via nasal prongs. The primary endpoint was median oxygen saturation in the peri-rapid sequence induction period, (2 minutes pre-intubation to 2 minutes post-intubation) for all patients. Secondary endpoints included the incidence of hypoxia in predetermined subgroups. RESULTS Of 725 patients included; 188 patients received standard treatment and 537 received the intervention. The overall incidence of hypoxia (first recorded SpO2 < 90%) was 16.7%; 10.9% had SpO2 < 85%. 98/725 patients (13.5%) were hypoxic post-intubation (final SpO2 < 90% 10 minutes post-intubation). Median SpO2 was 100% vs. 99% for the standard vs. intervention group. There was a statistically significant benefit from apnoeic oxygenation in reducing the frequency of peri-intubation hypoxia (SpO2 < =90%) for patients with initial SpO2 > 95%, p = 0.0001. The other significant benefit was observed in the recovery phase for patients with severe hypoxia prior to intubation. CONCLUSION Apnoeic oxygenation did not influence peri-intubation oxygen saturations, but it did reduce the frequency and duration of hypoxia in the post-intubation period. Given that apnoeic oxygenation is a simple low-cost intervention with a low complication rate, and that hypoxia can be detrimental to outcome, application of nasal cannulas during the drug-induced phase of emergency intubation may benefit a subset of patients undergoing emergency anaesthesia.
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Affiliation(s)
- Kate Crewdson
- London's Air Ambulance, London, UK. .,Intensive Care Unit, Gate 37, Level 2, Brunel Building, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK.
| | | | - Marius Rehn
- London's Air Ambulance, London, UK.,Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Samy Sadek
- Essex & Herts Air Ambulance Trust, Essex, UK
| | - David Lockey
- London's Air Ambulance, London, UK.,Blizard Institute, Queen Mary University of London, London, UK
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22
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Paterson E, Sanderson PM, Salisbury IS, Burgmann FP, Mohamed I, Loeb RG, Paterson NA. Evaluation of an enhanced pulse oximeter auditory display: a simulation study. Br J Anaesth 2020; 125:826-834. [DOI: 10.1016/j.bja.2020.05.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 10/23/2022] Open
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23
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Garzón JC, Sastre JA, Gómez-Ríos MÁ, López T, Garzón-Sánchez A, Pandit JJ. Comparing the dynamics of changes in regional cerebral oxygen saturation with arterial oxygen partial pressure with two techniques of preoxygenation in healthy adults. J Clin Anesth 2020; 68:110091. [PMID: 33069039 DOI: 10.1016/j.jclinane.2020.110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 09/02/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Affiliation(s)
- José Carlos Garzón
- Spanish Difficult Airway Group (GEVAD), Spain; Department of Anaesthesiology, Salamanca University Hospital, Salamanca, Spain
| | - José Alfonso Sastre
- Spanish Difficult Airway Group (GEVAD), Spain; Department of Anaesthesiology, Salamanca University Hospital, Salamanca, Spain
| | - Manuel Ángel Gómez-Ríos
- Spanish Difficult Airway Group (GEVAD), Spain; Department of Anaesthesia and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain; Anaesthesiology, Perioperative Medicine and Pain Management Research Group, A Coruña, Spain.
| | - Teresa López
- Spanish Difficult Airway Group (GEVAD), Spain; Department of Anaesthesiology, Salamanca University Hospital, Salamanca, Spain
| | - Ana Garzón-Sánchez
- Preventive Medicine and Quality Management Service, Hospital General Universitario Gregorio Marañón, Spain
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24
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Beeston TJ, Blissitt KJ. Decision making affecting the diagnosis of hypoxaemia in a pug. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Thomas James Beeston
- Veterinary Medicine and SurgeryThe University of Edinburgh College of Medicine and Veterinary MedicineEdinburghUK
| | - Karen J Blissitt
- Veterinary Medicine and SurgeryThe University of Edinburgh College of Medicine and Veterinary MedicineEdinburghUK
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25
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Smischney NJ, Khanna AK, Brauer E, Morrow LE, Ofoma UR, Kaufman DA, Sen A, Venkata C, Morris P, Bansal V. Risk Factors for and Outcomes Associated With Peri-Intubation Hypoxemia: A Multicenter Prospective Cohort Study. J Intensive Care Med 2020; 36:1466-1474. [PMID: 33000661 DOI: 10.1177/0885066620962445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Little is known about hypoxemia surrounding endotracheal intubation in the critically ill. Thus, we sought to identify risk factors associated with peri-intubation hypoxemia and its effects' on the critically ill. METHODS Data from a multicenter, prospective, cohort study enrolling 1,033 critically ill adults who underwent endotracheal intubation across 16 medical/surgical ICUs in the United States from July 2015-January 2017 were used to identify risk factors associated with peri-intubation hypoxemia and its effects on patient outcomes. We defined hypoxemia as any pulse oximetry ≤ 88% during and up to 30 minutes following endotracheal intubation. RESULTS In the full analysis (n = 1,033), 123 (11.9%) patients experienced the primary outcome. Five risk factors independently associated with our outcome were identified on multiple logistic regression: cardiac related reason for endotracheal intubation (OR 1.67, [95% CI 1.04, 2.69]); pre-intubation noninvasive ventilation (OR 1.66, [95% CI 1.09, 2.54]); emergency intubation (OR 1.65, [95% CI 1.06, 2.55]); moderate-severe difficult bag-mask ventilation (OR 2.68, [95% CI 1.72, 4.19]); and crystalloid administration within the preceding 24 hours (OR 1.24, [95% CI 1.07, 1.45]; per liter up to 4 liters). Higher baseline SpO2 was found to be protective (OR 0.93, [95% CI 0.91, 0.96]; per percent up to 97%). Consistent results were seen in a separate analysis on only stable patients (n = 921, 93 [10.1%]) (those without baseline hypoxemia ≤ 88%). Peri-intubation hypoxemia was associated with in-hospital mortality (OR 2.40, [95% CI 1.33, 4.31]; stable patients: OR 2.67, [95% CI 1.38, 5.17]) but not ICU length of stay (point estimate 0.9 days, [95% CI -1.0, 2.8 days]; stable patients: point estimate 1.5 days, [95% CI -0.4, 3.4 days]) after adjusting for age, body mass index, illness severity, airway related reason for intubation (i.e., acute respiratory failure), and baseline SPO2. CONCLUSIONS Patients with pre-existing noninvasive ventilation and volume loading who were intubated emergently in the setting of hemodynamic compromise with bag-mask ventilation described as moderate-severe were at increased risk for peri-intubation hypoxemia. Higher baseline oxygenation was found to be protective against peri-intubation hypoxemia. Peri-intubation hypoxemia was associated with in-hospital mortality but not ICU length of stay. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02508948 and Registered Report Identifier: RR2-10.2196/11101.
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Affiliation(s)
- Nathan J Smischney
- Department of Anesthesiology and Perioperative Medicine, 4352Mayo Clinic, Rochester, MN, USA.,HEModynamic and AIRway Management (HEMAIR) Study Group Mayo Clinic, Rochester, MN, USA
| | - Ashish K Khanna
- Outcomes Research Consortium, 2569Cleveland Clinic, Cleveland, OH, USA.,Department of Anesthesia, Section on Critical Care Medicine, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Ernesto Brauer
- Department of Critical Care Medicine, Aurora Health Care, Milwaukee, WI, USA
| | - Lee E Morrow
- Department of Critical Care Medicine, Creighton University, Omaha, NE, USA
| | - Uchenna R Ofoma
- Division of Critical Care Medicine, Geisinger Health System, Danville, PA, USA
| | - David A Kaufman
- Section of Pulmonary, Critical Care, and Sleep Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Ayan Sen
- Department of Critical Care Medicine, 4352Mayo Clinic, Jacksonville, FL, USA
| | - Chakradhar Venkata
- Department of Critical Care Medicine, 7537Mercy Hospital, St. Louis, MO, USA
| | - Peter Morris
- Department of Anesthesia and Critical Care Medicine, University of Kentucky, Lexington, KY, USA
| | - Vikas Bansal
- Department of Critical Care Medicine, 4352Mayo Clinic, Scottsdale, AZ, USA. Ofoma is now with Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA; Kaufman is now with Division of Pulmonary, Critical Care, and Sleep Medicine, NYU School of Medicine, New York, NY, USA
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26
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Mosier JM. Physiologically difficult airway in critically ill patients: winning the race between haemoglobin desaturation and tracheal intubation. Br J Anaesth 2020; 125:e1-e4. [DOI: 10.1016/j.bja.2019.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/09/2019] [Indexed: 12/20/2022] Open
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27
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Assessment of Difficult Intubation Predictors in Different Populations of Turkey. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.745672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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28
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Bonnet MP, Mercier FJ, Vicaut E, Galand A, Keita H, Baillard C. Incidence and risk factors for maternal hypoxaemia during induction of general anaesthesia for non-elective Caesarean section: a prospective multicentre study. Br J Anaesth 2020; 125:e81-e87. [PMID: 32303378 DOI: 10.1016/j.bja.2020.03.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Pregnant women are at increased risk of hypoxaemia during general anaesthesia. Our aim was to determine the incidence and the risk factors that contribute to hypoxaemia in this setting. METHODS Every woman 18 yr or older who underwent a non-elective Caesarean section under general anaesthesia was eligible to participate in this multicentre observational study. The primary endpoint was the incidence of hypoxaemia defined as the SpO2 ≤95%. The secondary endpoint was the incidence of difficult intubation defined as more than two attempts or failed intubation. RESULTS During the study period, 895 women were prospectively included in 17 maternity hospitals, accounting for 79% of women who had general anaesthesia for non-elective Caesarean section. Maternal hypoxaemia was observed in 172 women (19%; confidence interval [CI], 17-22%). Risk factors associated with hypoxaemia in the multivariate analysis were difficult or failed intubation (adjusted odds ratio [aOR]=19.1 [8.6-42.7], P<0.0001) and BMI >35 kg m-2 (aOR=0.53 [0.28-0.998], P=0.0495). Intubation was difficult in 40 women (4.5%; CI, 3.3-6%) and failed intubation occurred in five women (0.56%; CI, 0.1-1%). In the multivariate analysis, use of a hypnotic drug other than propofol was associated with difficult or failed intubation (aOR=25 [2-391], P=0.02). A propensity score confirmed that propofol was associated with a significant decreased risk of difficulty or failure to intubate (P<0.001). CONCLUSIONS Hypoxaemia during Caesarean sections was observed in 19% of women and was significantly associated with difficult or failed intubation. The use of propofol may protect against the occurrence of difficult intubation.
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Affiliation(s)
- Marie-Pierre Bonnet
- Department of Anaesthesiology and Critical Care, Armand Trousseau University Hospital, Assistance Publique-Hôpitaux de Paris, France; Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Université de Paris, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM INRA, Paris, France; Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Frédéric J Mercier
- Department of Anaesthesiology, Antoine Béclère University Hospital, Paris-Saclay University, Assistance Publique-Hôpitaux de Paris, Clamart, France
| | - Eric Vicaut
- Unité de Recherche Clinique, Lariboisière University Hospital, Paris 7 Diderot University, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anne Galand
- Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Hawa Keita
- Department of Anaesthesiology and Critical Care, Necker University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Unité de Recherche EA 7323 Pharmacologie et Evaluation des Thérapeutiques hez l'Enfant et la Femme Enceinte, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christophe Baillard
- Department of Anaesthesiology and Critical Care, Cochin-Port Royal University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
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How can I manage anaesthesia in obese patients? Anaesth Crit Care Pain Med 2020; 39:229-238. [DOI: 10.1016/j.accpm.2019.12.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 12/01/2019] [Accepted: 12/09/2019] [Indexed: 12/17/2022]
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Else SDN, Kovatsis PG. A Narrative Review of Oxygenation During Pediatric Intubation and Airway Procedures. Anesth Analg 2020; 130:831-840. [DOI: 10.1213/ane.0000000000004403] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
PURPOSE OF REVIEW The topic of perioperative hyperoxia remains controversial, with valid arguments on both the 'pro' and 'con' side. On the 'pro' side, the prevention of surgical site infections was a strong argument, leading to the recommendation of the use of hyperoxia in the guidelines of the Center for Disease Control and the WHO. On the 'con' side, the pathophysiology of hyperoxia has increasingly been acknowledged, in particular the pulmonary side effects and aggravation of ischaemia/reperfusion injuries. RECENT FINDINGS Some 'pro' articles leading to the Center for Disease Control and WHO guidelines advocating perioperative hyperoxia have been retracted, and the recommendations were downgraded from 'strong' to 'conditional'. At the same time, evidence that supports a tailored, more restrictive use of oxygen, for example, in patients with myocardial infarction or following cardiac arrest, is accumulating. SUMMARY The change in recommendation exemplifies that despite much work performed on the field of hyperoxia recently, evidence on either side of the argument remains weak. Outcome-based research is needed for reaching a definite recommendation.
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Yijun ZMD, Jianjian LMD, Qinqin YMD, Nannan SMD, Fei SMD, Yuxin SMD. Analysis of Characteristics of Bedside Chest Radiography in Critically Ill COVID-19 Patients. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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