澳大利亚皇家女子医院Kate A. Hodgson团队研究了新生儿气管插管时鼻高流量疗法对插管成功率的影响。该研究于2022年4月27日发表在《新英格兰医学杂志》上。

新生儿气管插管往往不止一次尝试，氧饱和度降低很常见。目前尚不清楚接受全身麻醉的儿童和成人在选择性插管期间延长去饱和时间的鼻高流量疗法是否可提高新生儿首次插管成功率。

研究组在澳大利亚两个三级新生儿重症监护病房进行了一项随机对照试验，招募接受经口气管插管的新生儿，分别进行鼻高流量治疗或标准治疗（无鼻高流量治疗或补充氧气）。根据试验中心、插管前是否用药以及婴儿胎龄（≤28周或>28周），将插管随机分为高流量组或标准治疗组。主要结局是首次尝试插管成功，未出现婴儿生理不稳定（定义为外周血氧饱和度比插管前基线水平绝对下降>20%，或心率<100次/分钟的心动过缓）。

主要意向治疗分析包括202名婴儿251次插管的结果；其中124次插管被分配到高流量组，127次被分配到标准治疗组。这些婴儿平均胎龄为27.9周，插管时平均体重为920克。高流量组124次插管中有62次（50.0%）成功插管，标准治疗组127次中有40次（31.5%）成功插管，即1名婴儿需要治疗6次才能获益。无论生理稳定性如何，高流量组的插管成功率为68.5%，标准治疗组为54.3%，校正后的风险差异为15.8个百分点。

综上，在澳大利亚两个三级新生儿重症监护病房接受气管插管的婴儿中，在插管过程中，鼻高流量疗法提高了首次插管成功的概率，且不会使婴儿出现生理不稳定。

附：英文原文

Title: Nasal High-Flow Therapy during Neonatal Endotracheal Intubation

Author: Kate A. Hodgson, M.B., B.S.,, Louise S. Owen, M.D.,, C. Omar F. Kamlin, D.Med.Sci.,, Calum T. Roberts, Ph.D.,, Sophie E. Newman, M.B., B.S.,, Kate L. Francis, M.Biostat.,, Susan M. Donath, M.A.,, Peter G. Davis, M.D.,, and Brett J. Manley, Ph.D.

Issue&Volume: 2022-04-27

Abstract:

Background

Neonatal endotracheal intubation often involves more than one attempt, and oxygen desaturation is common. It is unclear whether nasal high-flow therapy, which extends the time to desaturation during elective intubation in children and adults receiving general anesthesia, can improve the likelihood of successful neonatal intubation on the first attempt.

Methods

We performed a randomized, controlled trial to compare nasal high-flow therapy with standard care (no nasal high-flow therapy or supplemental oxygen) in neonates undergoing oral endotracheal intubation at two Australian tertiary neonatal intensive care units. Randomization of intubations to the high-flow group or the standard-care group was stratified according to trial center, the use of premedication for intubation (yes or no), and postmenstrual age of the infant (≤28 or >28 weeks). The primary outcome was successful intubation on the first attempt without physiological instability (defined as an absolute decrease in the peripheral oxygen saturation of >20% from the preintubation baseline level or bradycardia with a heart rate of <100 beats per minute) in the infant.

Results

The primary intention-to-treat analysis included the outcomes of 251 intubations in 202 infants; 124 intubations were assigned to the high-flow group and 127 to the standard-care group. The infants had a median postmenstrual age of 27.9 weeks and a median weight of 920 g at the time of intubation. A successful intubation on the first attempt without physiological instability was achieved in 62 of 124 intubations (50.0%) in the high-flow group and in 40 of 127 intubations (31.5%) in the standard-care group (adjusted risk difference, 17.6 percentage points; 95% confidence interval [CI], 6.0 to 29.2), for a number needed to treat of 6 (95% CI, 4 to 17) for 1 infant to benefit. Successful intubation on the first attempt regardless of physiological stability was accomplished in 68.5% of the intubations in the high-flow group and in 54.3% of the intubations in the standard-care group (adjusted risk difference, 15.8 percentage points; 95% CI, 4.3 to 27.3).

Conclusions

Among infants undergoing endotracheal intubation at two Australian tertiary neonatal intensive care units, nasal high-flow therapy during the procedure improved the likelihood of successful intubation on the first attempt without physiological instability in the infant.

DOI: 10.1056/NEJMoa2116735

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2116735