Osama Abou-Arab1, Pierre-Grégoire Guinot, Evgeny Dimov, Momar Diouf, Bruno de Broca, Aurélie Biet, Rody Zaatar, Eugénie Bernard, Hervé Dupont, Emmanuel Lorne. 1. From the Anaesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet (OAA, PGG, BDB, EB, HD, EL); INSERM U1088, Jules Verne University of Picardy, Amiens (PGG, HD, EL); Clinique Sainte Isabelle, Route d'Amiens, Abbeville (ED); Centre de Recherche Clinique CHU Amiens (MD); and ENT Surgery Department, Amiens University Hospital, Place Victor Pauchet, Amiens, France (AB, RZ).
Abstract
BACKGROUND: It has been suggested that oxygenation using pressure support ventilation (PSV) before general anaesthesia can reduce the duration of non-hypoxaemic apnoea. OBJECTIVE: The objective was to determine whether or not pre-oxygenation with PSV increases the duration of non-hypoxaemic apnoea in non-obese patients during pan-endoscopy. DESIGN: A randomised, controlled trial. SETTING:Amiens University Hospital, France. PATIENTS: Fifty patients scheduled for ENT pan-endoscopy with a BMI lower than 35 kg m(-2). INTERVENTION: Patients scheduled for pan-endoscopy were enrolled to receive either 100% oxygen at neutral pressure (the control group) or 100% oxygen with positive-pressure ventilation (a positive inspiratory pressure of 4 cmH2O and a positive end-expiratory pressure of 4 cmH2O; the PSV group) during spontaneous ventilation with a face mask. The goal of pre-oxygenation was to obtain an end-tidal oxygen concentration of more than 90% prior to induction of anaesthesia. MAIN OUTCOME MEASURES: The primary efficacy criterion was the duration of non-hypoxaemic apnoea (i.e. before the peripheral capillary oxygen saturation fell to 90%). Secondary outcomes were duration of pre-oxygenation, pre-oxygenation failure and tolerance. RESULTS: The mean (interquartile range) duration of non-hypoxaemic apnoea was longer in the PSV group [598 (447 to 717) s] than in the control group [310 (217 to 451) s] (P < 0.001). Oxygenation time was shorter in the PSV group [190 (159 to 225) s] than in the control group [245 (151 to 435) s] (P = 0.037). Pre-oxygenation was unsuccessful (i.e. end-tidal oxygen concentration was < 90%) in 20% of the patients in the control group but none in the PSV group. The intergroup difference in the duration of pan-endoscopy was not significant. Tolerance was good or very good in all patients. CONCLUSION: Our results show that pre-oxygenation with PSV is associated with a longer duration of non-hypoxaemic apnoea and a lower frequency of manual reventilation during ENT pan-endoscopy. CLINICALTRIALS. GOV REGISTRATION NUMBER: NCT02167334.
RCT Entities:
BACKGROUND: It has been suggested that oxygenation using pressure support ventilation (PSV) before general anaesthesia can reduce the duration of non-hypoxaemic apnoea. OBJECTIVE: The objective was to determine whether or not pre-oxygenation with PSV increases the duration of non-hypoxaemic apnoea in non-obesepatients during pan-endoscopy. DESIGN: A randomised, controlled trial. SETTING: Amiens University Hospital, France. PATIENTS: Fifty patients scheduled for ENT pan-endoscopy with a BMI lower than 35 kg m(-2). INTERVENTION: Patients scheduled for pan-endoscopy were enrolled to receive either 100% oxygen at neutral pressure (the control group) or 100% oxygen with positive-pressure ventilation (a positive inspiratory pressure of 4 cmH2O and a positive end-expiratory pressure of 4 cmH2O; the PSV group) during spontaneous ventilation with a face mask. The goal of pre-oxygenation was to obtain an end-tidal oxygen concentration of more than 90% prior to induction of anaesthesia. MAIN OUTCOME MEASURES: The primary efficacy criterion was the duration of non-hypoxaemic apnoea (i.e. before the peripheral capillary oxygen saturation fell to 90%). Secondary outcomes were duration of pre-oxygenation, pre-oxygenation failure and tolerance. RESULTS: The mean (interquartile range) duration of non-hypoxaemic apnoea was longer in the PSV group [598 (447 to 717) s] than in the control group [310 (217 to 451) s] (P < 0.001). Oxygenation time was shorter in the PSV group [190 (159 to 225) s] than in the control group [245 (151 to 435) s] (P = 0.037). Pre-oxygenation was unsuccessful (i.e. end-tidal oxygen concentration was < 90%) in 20% of the patients in the control group but none in the PSV group. The intergroup difference in the duration of pan-endoscopy was not significant. Tolerance was good or very good in all patients. CONCLUSION: Our results show that pre-oxygenation with PSV is associated with a longer duration of non-hypoxaemic apnoea and a lower frequency of manual reventilation during ENT pan-endoscopy. CLINICALTRIALS. GOV REGISTRATION NUMBER: NCT02167334.