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临床试验/NCT05601570
NCT05601570尚未招募不适用

Impact of the Experience of Anaesthetists in Changing Ventilation Strategies During Panendoscopy on the Incidence of Intraoperative Hypoxaemia

Centre Hospitalier Universitaire de Besancon1 个研究点 分布在 1 个国家目标入组 850 人开始时间: 2024年4月10日最近更新:
适应症

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

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

申办方类型
Other
责任方
Principal Investigator
主要研究者

David Ferreira

Principal Investigator

Centre Hospitalier Universitaire de Besancon

研究点 (1)

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