Impact of the Experience of Anaesthetists in Changing Ventilation Strategies During Panendoscopy on the Incidence of Intraoperative Hypoxaemia
试验速览
- 阶段
- 不适用
- 状态
- 尚未招募
- 入组人数
- 850
- 试验地点
- 1
- 主要终点
- Proportion of patients with oxygen desaturation
研究概览
简要总结
High Flow Nasal Oxygen Therapy (HFNO) is a new oxygenation tool that is becoming increasingly widespread in perioperative anaesthesia. The benefits of this oxygenation tool are based on different physiological principles. These include the reduction of dead space by "flushing" the nasopharyngeal cavities, positive airway pressure and the warming and humidification of inspired air. In addition, the high flow rates used ensure that the patient's inspiratory demand is covered, allowing for the delivery of oxygen-enriched and controlled air. It is simple to use, with the only parameters to be set being gas flow and FiO2. The use of HFNO appears to allow a prolongation of apnoea time without desaturation in apneic ventilation.
Mainly studied in ENT surgery because of the interest that this oxygenation strategy presents with the absence of recourse to oro-tracheal intubation (OTI), several authors will use it in the framework of micro-laryngoscopy surgery in suspension. However, its use as an oxygenation strategy during panendoscopy has been little explored. Panendoscopy is a common procedure that requires deep and short anesthesia. The main challenge is the sharing of the airway between the anesthesia team and the surgical team. Learning to use this new method or the impact of operator experience has never been explored.
详细描述
Currently, there are several strategies to ensure oxygenation during this specific type of ENT management:
- Mechanical ventilation with oro-tracheal intubation (OTI)
- Face mask ventilation (FMV)
- Jet ventilation
- HFNO Each of these methods has advantages and disadvantages, which explains why there are no clear recommendations to date on the preferred anesthesia and oxygenation technique. Regardless of the method chosen, the risks remain significant for the patient, particularly the risk of hypoxemia during a desaturation episode.
For several years, the strategy of oxygenation during panendoscopy and the number of practitioners performing this procedure has evolved in our centre.
- 2017, with the arrival of the HFNO in the operating room.
- 2020, during the SARS-CoV2 pandemic, changes in the organisation of the anaesthesiology department had to take place and the number of practitioners performing this procedure increased significantly.
The main objective of this study was to evaluate the impact of the evolution periods of the oxygenation strategies and the experience of the operators on the incidence of patients with at least one intra-procedural hypoxemia (SpO2 < 90% for more than one minute).
研究设计
- 研究类型
- Observational
- 观察模型
- Cohort
- 时间视角
- Retrospective
入排标准
- 年龄范围
- 18 Years 至 —(Adult, Older Adult)
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •major patients receiving panendoscopy
排除标准
- •panendoscopies performed in combination with another invasive procedure that may alter anaesthetic management
结局指标
主要结局
Proportion of patients with oxygen desaturation
时间窗: during the intervention (max 6hours)from induction of anaesthesia to discharge from the operating theatre
Proportion of patients with oxygen desaturation (SpO2 \< 90%) for more than 1 minute.
次要结局
- Proportion of patients within each of the ventilation modalities used in panendoscopies(during the intervention (max 6hours)from induction of anaesthesia to discharge from the operating theatre)
- Proportion of patients requiring oro-tracheal intubation
- Duration of the procedure(during the intervention (max 6hours)from induction of anaesthesia to discharge from the operating theatre)
- Incidence of major intraoperative complications(during the intervention (max 6hours)from induction of anaesthesia to discharge from the operating theatre)
研究者
David Ferreira
Principal Investigator
Centre Hospitalier Universitaire de Besancon
