Cargando…

Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia

BACKGROUND: For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic submucosal dissection (ESD), intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous sedation, even at mild to moderate depth of anesthesia, there i...

Descripción completa

Detalles Bibliográficos
Autores principales: Ayuse, Takao, Yamguchi, Naoyuki, Hashiguchi, Keiichi, Sanuki, Takuro, Mishima, Gaku, Kurata, Shinji, Hosogaya, Naoki, Nakashima, Sawako, Pinkham, Max, Tatkov, Stanislav, Nakao, Kazuhiko
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220533/
https://www.ncbi.nlm.nih.gov/pubmed/32384465
http://dx.doi.org/10.1097/MD.0000000000020038
_version_ 1783533184094306304
author Ayuse, Takao
Yamguchi, Naoyuki
Hashiguchi, Keiichi
Sanuki, Takuro
Mishima, Gaku
Kurata, Shinji
Hosogaya, Naoki
Nakashima, Sawako
Pinkham, Max
Tatkov, Stanislav
Nakao, Kazuhiko
author_facet Ayuse, Takao
Yamguchi, Naoyuki
Hashiguchi, Keiichi
Sanuki, Takuro
Mishima, Gaku
Kurata, Shinji
Hosogaya, Naoki
Nakashima, Sawako
Pinkham, Max
Tatkov, Stanislav
Nakao, Kazuhiko
author_sort Ayuse, Takao
collection PubMed
description BACKGROUND: For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic submucosal dissection (ESD), intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous sedation, even at mild to moderate depth of anesthesia, there is always a risk of upper airway obstruction due to a relaxation of the upper airway muscles. With the advent of Nasal High Flow (NHF) devices that allow humidified high flow air through the nasal cavity, can be used as a respiratory management method in the context of anesthesia. AIRVO is commonly used for patients with obstructive sleep apnea and other respiratory disorders. This device uses a mild positive pressure load (several cmH(2)O) that improves carbon dioxide (CO(2)) washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia. This study aims to maintain upper airway patency by applying NHF with air (AIRVO) as a respiratory management method during intravenous anesthesia for patients undergoing an ESD. In addition, this study investigates whether the use of an NHF device in this context can prevent intraoperative hypercapnia and hypoxemia. METHODS/DESIGN: This study design employed 2 groups of subjects. Both received intravenous anesthesia while undergoing an ESD, and 1 group also used a concurrent nasal cannula NHF device. Here we examine if the use of an NHF device during intravenous anesthesia can prevent hypoxemia and hypercapnia, which could translate to improved anesthesia management. Efficacy endpoints were assessed using a transcutaneous CO(2) monitor. This device measured the changes in CO(2) concentration during treatment. Transcutaneous CO(2) (PtcCO(2)) concentrations of 60 mmHg or more (PaCO(2) > 55 mmHg) were considered marked hypercapnia. PtcCO(2) concentrations of 50 to 60 mmHg or more (equivalent to PaCO(2) > 45 mmHg) were considered moderate hypercapnia. Furthermore, the incidence of hypoxemia with a transcutaneous oxygen saturation value of 90% or less, and whether the use of NHF was effective in preventing this adverse clinical event were evaluated. DISCUSSION: The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ESD under anesthesia, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use of this device. TRIAL REGISTRATION: The study was registered the jRCTs 072190022. URL https://jrct.niph.go.jp/en-latest-detail/jRCTs072190022
format Online
Article
Text
id pubmed-7220533
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Wolters Kluwer Health
record_format MEDLINE/PubMed
spelling pubmed-72205332020-06-15 Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia Ayuse, Takao Yamguchi, Naoyuki Hashiguchi, Keiichi Sanuki, Takuro Mishima, Gaku Kurata, Shinji Hosogaya, Naoki Nakashima, Sawako Pinkham, Max Tatkov, Stanislav Nakao, Kazuhiko Medicine (Baltimore) 3300 BACKGROUND: For relatively invasive upper gastrointestinal endoscopy procedures, such as an endoscopic submucosal dissection (ESD), intravenous anesthesia is routinely used to reduce patient anxiety. However, with the use of intravenous sedation, even at mild to moderate depth of anesthesia, there is always a risk of upper airway obstruction due to a relaxation of the upper airway muscles. With the advent of Nasal High Flow (NHF) devices that allow humidified high flow air through the nasal cavity, can be used as a respiratory management method in the context of anesthesia. AIRVO is commonly used for patients with obstructive sleep apnea and other respiratory disorders. This device uses a mild positive pressure load (several cmH(2)O) that improves carbon dioxide (CO(2)) washout and reduces rebreathing to improve respiratory function and therefore is widely used to prevent hypoxemia and hypercapnia. This study aims to maintain upper airway patency by applying NHF with air (AIRVO) as a respiratory management method during intravenous anesthesia for patients undergoing an ESD. In addition, this study investigates whether the use of an NHF device in this context can prevent intraoperative hypercapnia and hypoxemia. METHODS/DESIGN: This study design employed 2 groups of subjects. Both received intravenous anesthesia while undergoing an ESD, and 1 group also used a concurrent nasal cannula NHF device. Here we examine if the use of an NHF device during intravenous anesthesia can prevent hypoxemia and hypercapnia, which could translate to improved anesthesia management. Efficacy endpoints were assessed using a transcutaneous CO(2) monitor. This device measured the changes in CO(2) concentration during treatment. Transcutaneous CO(2) (PtcCO(2)) concentrations of 60 mmHg or more (PaCO(2) > 55 mmHg) were considered marked hypercapnia. PtcCO(2) concentrations of 50 to 60 mmHg or more (equivalent to PaCO(2) > 45 mmHg) were considered moderate hypercapnia. Furthermore, the incidence of hypoxemia with a transcutaneous oxygen saturation value of 90% or less, and whether the use of NHF was effective in preventing this adverse clinical event were evaluated. DISCUSSION: The purpose of this study was to obtain evidence for the utility of NHF as a potential therapeutic device for patients undergoing an ESD under anesthesia, assessed by determining if the incidence rates of hypercapnia and hypoxemia decreased in the NHF device group, compared to the control group that did not use of this device. TRIAL REGISTRATION: The study was registered the jRCTs 072190022. URL https://jrct.niph.go.jp/en-latest-detail/jRCTs072190022 Wolters Kluwer Health 2020-05-08 /pmc/articles/PMC7220533/ /pubmed/32384465 http://dx.doi.org/10.1097/MD.0000000000020038 Text en Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by/4.0 This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0
spellingShingle 3300
Ayuse, Takao
Yamguchi, Naoyuki
Hashiguchi, Keiichi
Sanuki, Takuro
Mishima, Gaku
Kurata, Shinji
Hosogaya, Naoki
Nakashima, Sawako
Pinkham, Max
Tatkov, Stanislav
Nakao, Kazuhiko
Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
title Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
title_full Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
title_fullStr Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
title_full_unstemmed Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
title_short Study on prevention of hypercapnia by Nasal High Flow in patients with endoscopic submucosal dissection during intravenous anesthesia
title_sort study on prevention of hypercapnia by nasal high flow in patients with endoscopic submucosal dissection during intravenous anesthesia
topic 3300
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220533/
https://www.ncbi.nlm.nih.gov/pubmed/32384465
http://dx.doi.org/10.1097/MD.0000000000020038
work_keys_str_mv AT ayusetakao studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT yamguchinaoyuki studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT hashiguchikeiichi studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT sanukitakuro studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT mishimagaku studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT kuratashinji studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT hosogayanaoki studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT nakashimasawako studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT pinkhammax studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT tatkovstanislav studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia
AT nakaokazuhiko studyonpreventionofhypercapniabynasalhighflowinpatientswithendoscopicsubmucosaldissectionduringintravenousanesthesia