1
|
Hellerman Itzhaki M, Hoshen S, Singer P, Statlender L, Fishman G, Bendavid I, Kagan I. The effect of mechanical ventilation compared to high-flow nasal cannula on gastric residual volume and reflux events using novel automated technology. Clin Nutr ESPEN 2024; 63:68-73. [PMID: 38923467 DOI: 10.1016/j.clnesp.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/21/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND & AIM High flow nasal cannula (HFNC) oxygen therapy is frequently used following extubation. A case report, utilizing an innovative medical technology (The smART + Platform, ART MEDICAL Ltd., Netanya, Israel) that enables the detection of gastric refluxes and gastric residual volumes (GRV), has suggested that HFNC may be associated with increased reflux events and GRV. This study measured reflux events and GRV using smART+ in mechanically ventilated patients before and after extubation while they were receiving HFNC therapy. We aim to show if there is a significant difference in reflux events and GRV between HFNC users and mechanically ventilated patients. METHODS This is a post hoc analysis examines data of a randomized controlled trial (RCT) involving critically ill adult patients who received enteral nutrition through the smART + Platform. The study was approved by the local ethics committee. We compared the frequency and amplitude of reflux events and GRV in mechanically ventilated patients. These parameters were assessed both 3 h before extubation and subsequently after extubation when the patients were connected to HFNC. Patients served as their own controls. To evaluate the differences between the pre- and post-extubation measurements, we applied a parametric paired t-test. RESULTS Ten patients (mean age of 58 years; mean APACHE II score 22; mean 3.9 days of mechanical ventilation) were included. Three hours prior extubation the mean GRV was 4.1 ml/h compared to 14.03 ml/h on HFNC (p = 0.004). The mean frequency of major reflux events was 2.33/h in ventilated patients versus 4.4/h in the HFNC patients (p = 0.73). The mean frequency of major reflux events was 9.17/h in ventilated patients versus 9.83/h in HFNC patients (p = 0.14). CONCLUSIONS Leveraging the smART + Platform, we demonstrated that the use of HFNC significantly increases GRV compared with patients on mechanical ventilation and may increase the frequency of major reflux events, thereby increasing the risk of aspiration. Further studies are required to support our conclusions.
Collapse
Affiliation(s)
- Moran Hellerman Itzhaki
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel.
| | - Shay Hoshen
- The Adelson School of Medicine, Ariel University, Israel
| | - Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel
| | - Liran Statlender
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel
| | - Gay Fishman
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel
| | - Itai Bendavid
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel
| | - Ilya Kagan
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Israel; Sackler Medical School, Tel Aviv University, Israel
| |
Collapse
|
2
|
Li YH, Lei GY, Guo J, Yi M, Fu YJ, Wang GY. Effect of maternal oxygen supplementation for parturient undergoing elective cesarean section by high-flow nasal oxygen compared with room air on fetal acidemia: study protocol for a randomized controlled trial. Trials 2024; 25:73. [PMID: 38254137 PMCID: PMC10802011 DOI: 10.1186/s13063-024-07927-y] [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: 09/26/2023] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Maternal oxygen supplementation is usually used as an intrauterine resuscitation technique to prevent fetal hypoxia and acidemia during delivery. However, there has been a great deal of controversy regarding the effects of prophylactic maternal oxygen during cesarean section, during which the incidence of fetal acidemia seems to be higher compared with that during labor. High-flow nasal oxygen (HFNO) can improve oxygenation better in patients with high-flow oxygen airflow. The purpose of this study is to determine whether maternal oxygen supplementation with HFNO has a positive effect on fetal acidemia during cesarean section through umbilical arterial blood gas analysis. METHOD This prospective, single-center, randomized, double-blinded trial will enroll 120 patients undergoing cesarean section. Participants will be randomly assigned to the HFNO group or air group at a 1:1 ratio. For parturients in the HFNO group, the flow rate is 40L/min, and the oxygen is heated to 37℃ with humidity 100% oxygen concentration through the Optiflow high-flow nasal oxygen system. And for the air group, the flow rate is 2 L/min with an air pattern through the same device. The primary outcome was umbilical artery (UA) lactate. Secondary outcomes include UA pH, PO2, PCO2, BE, the incidence of pH < 7.20 and pH < 7.10, Apgar scores at 1 and 5 min, and neonatal adverse outcomes. DISCUSSION Our study is the first trial investigating whether maternal oxygen supplementation with HFNO can reduce the umbilical artery lactate levels and the incidence of fetal acidemia in cesarean section under combined spinal-epidural anesthesia. TRIAL REGISTRATION ClinicalTrials.gov NCT05921955. Registered on 27 June 2023.
Collapse
Affiliation(s)
- Yun-Hui Li
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Gui-Yu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Jun Guo
- Department of Gynecologic and Obstetric, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Meng Yi
- Department of Gynecologic and Obstetric, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Yu-Jing Fu
- Department of Gynecologic and Obstetric, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Gu-Yan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
| |
Collapse
|
3
|
Bishop DG, Fernandes NL, Dyer RA, Sumikura H, Okada H, Suga Y, Shen F, Xu Z, Liu Z, Vasco M, George RB, Guasch E. Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America. Int J Obstet Anesth 2023; 54:103648. [PMID: 36930996 DOI: 10.1016/j.ijoa.2023.103648] [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: 01/30/2023] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
South Africa is classified as a low- and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia practitioners in resource-limited environments. In Japan, obstetricians administer anaesthesia for 40% of caesarean deliveries and 80% of labour analgesia. Centralisation of delivery facilities is now occurring and it is expected that obstetric anaesthesiologists will be available 24 h a day in centralised facilities in the future. In China, improvements in women's reproductive, maternal, neonatal, child, and adolescent health are critical government policies. Obstetric anaesthesia, especially labour analgesia, has received unprecedented attention. Chinese obstetric anaesthesiologists are passionate about clinical research, focusing on efficacy, safety, and topical issues. The Latin-American region has different landscapes, people, languages, and cultures, and is one of the world's regions with the most inequality. There are large gaps in research, knowledge, and health services, and the World Federation of Societies of Anaesthesiologists is committed to working with governmental and non-governmental organisations to improve patient care and access to safe anaesthesia. Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American healthcare. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.
Collapse
Affiliation(s)
- D G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - N L Fernandes
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - H Sumikura
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - H Okada
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - Y Suga
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - F Shen
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Xu
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Liu
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - M Vasco
- Director of Clinical Simulation, Universidad CES, Medellín, Colombia
| | - R B George
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - E Guasch
- Division Chief Obstetric Anaesthesia, Hospital Universitario La Paz, Madrid, Spain.
| |
Collapse
|