“…[31,[45][46] A systematic review and meta-analysis examined the benefits of high-flow nasal cannula in the peri-intubation period of patients in ICU, and found that there was no difference in severe O2 desaturation, serious complications and oxygenation compared with conventional oxygen therapy. [47] Meta-analysis showed no statistically significant difference(p=0.43) in EtCO2 and PaCO2 between HFNO group and FMV group. And subgroup analysis also showed no significant difference(p=0.09) in the EtCO2 versus PaCO2.…”
BackgroundIn recent years, high flow nasal oxygen(HFNO) has been widely used in clinic, especially in perioperative period.Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial.Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis ofRCTs.MethodsEMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevantrandomized controlled trails(RCTs) on the effectiveness of HFNO versus standard facemask ventilation(FMV) inpre- and apenic oxygenation. Studies involving one of the following six indicators: (1)Arterial oxygen partialpressure(PaO2), (2)End expiratory oxygen concentration(EtO2), (3)Safe apnoea time, (4)Minimum pulse oxygensaturation(SpO2min), (5)Oxygenation(O2) desaturation, (6)End expiratory carbon dioxide(EtCO2) or Arterial carbondioxide partial pressure(PaCO2) were included. We select random effect model or fixed effect model for analysisaccording to the heterogeneity of the article, and express it as the mean difference(MD) or risk ratio(RR) with aconfidence interval of 95%(95%CI). We conducted a risk assessment of bias for eligible studies and assessed theoverall quality of evidence for each outcome.Results14 RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMVgroup with a MD(95% CI) of 57.38 mmHg(25.65 to 89.10; p=0.0004) after preoxygenation and the safe apnoeatime was significantly longer with a MD(95% CI) of 86.93 seconds(44.35 to 129.51; p<0.0001) during anesthesiainduction. There were no significant statistical difference in the minimum O2 saturation, CO2 accumulation, endexpiratory oxygen concentration and O2 desaturation rate during anesthesia induction between the two groups.ConclusionsThis systematic review and meta-analysis suggests that HFNO should be considered as an airway managementtool for patients with high-risk hypoxemia or difficult airway during anesthesia induction. Compared with FMV,continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safeapnoea time in surgical patients.
“…[31,[45][46] A systematic review and meta-analysis examined the benefits of high-flow nasal cannula in the peri-intubation period of patients in ICU, and found that there was no difference in severe O2 desaturation, serious complications and oxygenation compared with conventional oxygen therapy. [47] Meta-analysis showed no statistically significant difference(p=0.43) in EtCO2 and PaCO2 between HFNO group and FMV group. And subgroup analysis also showed no significant difference(p=0.09) in the EtCO2 versus PaCO2.…”
BackgroundIn recent years, high flow nasal oxygen(HFNO) has been widely used in clinic, especially in perioperative period.Many studies have discussed the role of HFNO in pre- and apneic oxygenation, but their results are controversial.Our study aimed to examine the effectiveness of HFNO in pre- and apneic oxygenation by a meta-analysis ofRCTs.MethodsEMBASE, PUBMED, and COCHRANE LIBRARY databases were searched from inception to July 2021 for relevantrandomized controlled trails(RCTs) on the effectiveness of HFNO versus standard facemask ventilation(FMV) inpre- and apenic oxygenation. Studies involving one of the following six indicators: (1)Arterial oxygen partialpressure(PaO2), (2)End expiratory oxygen concentration(EtO2), (3)Safe apnoea time, (4)Minimum pulse oxygensaturation(SpO2min), (5)Oxygenation(O2) desaturation, (6)End expiratory carbon dioxide(EtCO2) or Arterial carbondioxide partial pressure(PaCO2) were included. We select random effect model or fixed effect model for analysisaccording to the heterogeneity of the article, and express it as the mean difference(MD) or risk ratio(RR) with aconfidence interval of 95%(95%CI). We conducted a risk assessment of bias for eligible studies and assessed theoverall quality of evidence for each outcome.Results14 RCTs and 1012 participants were finally included. We found the PaO2 was higher in HFNO group than FMVgroup with a MD(95% CI) of 57.38 mmHg(25.65 to 89.10; p=0.0004) after preoxygenation and the safe apnoeatime was significantly longer with a MD(95% CI) of 86.93 seconds(44.35 to 129.51; p<0.0001) during anesthesiainduction. There were no significant statistical difference in the minimum O2 saturation, CO2 accumulation, endexpiratory oxygen concentration and O2 desaturation rate during anesthesia induction between the two groups.ConclusionsThis systematic review and meta-analysis suggests that HFNO should be considered as an airway managementtool for patients with high-risk hypoxemia or difficult airway during anesthesia induction. Compared with FMV,continuous use of HFNO during anesthesia induction can significantly improve oxygenation and prolong safeapnoea time in surgical patients.
“…a. High-flow nasal oxygen may help avert intubation in patients with hypoxemic respiratory failure and prevent reintubation after extubation of critically ill patients and postoperative patients compared to conventional oxygen therapy. [91][92][93][94] High-flow nasal oxygen has also been associated with a trend toward less nosocomial pneumonia in patients with hypoxemic respiratory failure. 95 b. NIPPV is associated with lower rates of intubation, reintubation, VAP, and mortality compared to conventional oxygen therapy in patients with acute hypercapnic or hypoxemic respiratory failure.…”
Section: Essential Practices For Preventing Vap And/or Vaes In Adult ...mentioning
The purpose of this document is to highlight practical recommendations to assist acute care hospitals to prioritize and implement strategies to prevent ventilator-associated pneumonia (VAP), ventilator-associated events (VAE), and non-ventilator hospital-acquired pneumonia (NV-HAP) in adults, children, and neonates. This document updates the Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care Hospitals published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA), and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
“…Eine nasale High-Flow(nHF)-Sauerstofftherapie als Alternative zur reinen Sauerstoffgabe konnte die PPC-Inzidenz nicht senken 70 , wobei bei einer entsprechenden Risikopopulation die Reduktion der Reintubationsraten mittels nHF mit einer NIV-Therapie vergleichbar ist. 71 Daher wird die prophylaktische nHF nur für Risikopatient*innen als Alternative zur CPAP/NIV-Therapie empfohlen. 71 Es ist anzumerken, dass die konventionelle prophylaktische Sauerstoffgabe post-operativ risikobehaftet ist, da sie im Gegensatz zur CPAP-Therapie das Auftreten oder die Rückbildung von Atelektasen negativ beeinflusst und eine mögliche Hypoventilation aufgrund eines Sedativa-, Opiat- oder Muskelrelaxanzien-Überhangs bei häufig fehlender Überwachung des endtidalen oder arteriellen CO 2 -Gehaltes maskiert.…”
“… 71 Daher wird die prophylaktische nHF nur für Risikopatient*innen als Alternative zur CPAP/NIV-Therapie empfohlen. 71 Es ist anzumerken, dass die konventionelle prophylaktische Sauerstoffgabe post-operativ risikobehaftet ist, da sie im Gegensatz zur CPAP-Therapie das Auftreten oder die Rückbildung von Atelektasen negativ beeinflusst und eine mögliche Hypoventilation aufgrund eines Sedativa-, Opiat- oder Muskelrelaxanzien-Überhangs bei häufig fehlender Überwachung des endtidalen oder arteriellen CO 2 -Gehaltes maskiert. …”
Die Inzidenz postoperativer pulmonaler Komplikationen variiert je nach Art des chirurgischen Eingriffes und dem Patient*innenkollektiv. Unabhängig davon stellen pulmonale Komplikationen einen wesentlichen Faktor für die postoperative Mortalität dar. Während der chirurgische Eingriff sowie die Komorbiditäten der Patient*innen nicht veränderbar sind, gibt es einige perioperative Faktoren, die einen wesentlichen Einfluss auf die Entwicklung pulmonaler Komplikationen haben. Die Kenntnis dieser Faktoren sowie das Bewusstsein über Häufigkeit, Diagnose und Therapie ermöglichen eine bessere Betreuung der uns Anästhesist*innen anvertrauten Patient*innen.
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