Shuailei Wang (MD) , Jiaming Ji (MD) , Chang Xiong (MD) , Weilong Zhong (MD) , Liping Li (MD) , Shengyuan Gong (MD) , Jiamei Lu (MD) , Ziqing Hei (MD) , Weifeng Yao (MD) , Chaojin Chen (MD)
{"title":"比较在程序性镇静下进行消化内镜检查时预防低氧血症的氧气疗法：系统综述和网络荟萃分析。","authors":"Shuailei Wang (MD) , Jiaming Ji (MD) , Chang Xiong (MD) , Weilong Zhong (MD) , Liping Li (MD) , Shengyuan Gong (MD) , Jiamei Lu (MD) , Ziqing Hei (MD) , Weifeng Yao (MD) , Chaojin Chen (MD)","doi":"10.1016/j.jclinane.2024.111586","DOIUrl":null,"url":null,"abstract":"<div><h3>Study objective</h3><p>Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined.</p></div><div><h3>Design</h3><p>A systematic review and network meta-analysis of randomized clinical trials.</p></div><div><h3>Setting</h3><p>Digestive Endoscopy Center.</p></div><div><h3>Patients</h3><p>Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation.</p></div><div><h3>Interventions</h3><p>Pubmed, MEDLINE, Web of Science, Embase, and <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span>. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included.</p></div><div><h3>Measurement</h3><p>The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO<sub>2</sub>). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p></div><div><h3>Main results</h3><p>We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV <em>vs.</em> NC, OR = 0.16, 95% CI: 0.08–0.31, 95% PrI: 0.06–0.41), followed by Wei nasal jet tube (WNJT) (WNJT <em>vs.</em> NC, OR = 0.17, 95% CI: 0.10–0.30, 95% PrI: 0.07–0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC.</p></div><div><h3>Conclusions</h3><p>During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.</p></div>","PeriodicalId":15506,"journal":{"name":"Journal of Clinical Anesthesia","volume":"98 ","pages":"Article 111586"},"PeriodicalIF":5.0000,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparing oxygen therapies for hypoxemia prevention during gastrointestinal endoscopy under procedural sedation: A systematic review and network meta-analysis\",\"authors\":\"Shuailei Wang (MD) , Jiaming Ji (MD) , Chang Xiong (MD) , Weilong Zhong (MD) , Liping Li (MD) , Shengyuan Gong (MD) , Jiamei Lu (MD) , Ziqing Hei (MD) , Weifeng Yao (MD) , Chaojin Chen (MD)\",\"doi\":\"10.1016/j.jclinane.2024.111586\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Study objective</h3><p>Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined.</p></div><div><h3>Design</h3><p>A systematic review and network meta-analysis of randomized clinical trials.</p></div><div><h3>Setting</h3><p>Digestive Endoscopy Center.</p></div><div><h3>Patients</h3><p>Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation.</p></div><div><h3>Interventions</h3><p>Pubmed, MEDLINE, Web of Science, Embase, and <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span>. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included.</p></div><div><h3>Measurement</h3><p>The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO<sub>2</sub>). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.</p></div><div><h3>Main results</h3><p>We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV <em>vs.</em> NC, OR = 0.16, 95% CI: 0.08–0.31, 95% PrI: 0.06–0.41), followed by Wei nasal jet tube (WNJT) (WNJT <em>vs.</em> NC, OR = 0.17, 95% CI: 0.10–0.30, 95% PrI: 0.07–0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC.</p></div><div><h3>Conclusions</h3><p>During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.</p></div>\",\"PeriodicalId\":15506,\"journal\":{\"name\":\"Journal of Clinical Anesthesia\",\"volume\":\"98 \",\"pages\":\"Article 111586\"},\"PeriodicalIF\":5.0000,\"publicationDate\":\"2024-08-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Anesthesia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0952818024002150\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ANESTHESIOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Anesthesia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0952818024002150","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}
Comparing oxygen therapies for hypoxemia prevention during gastrointestinal endoscopy under procedural sedation: A systematic review and network meta-analysis
Study objective
Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined.
Design
A systematic review and network meta-analysis of randomized clinical trials.
Setting
Digestive Endoscopy Center.
Patients
Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation.
Interventions
Pubmed, MEDLINE, Web of Science, Embase, and Clinicaltrials.gov. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included.
Measurement
The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO2). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Main results
We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV vs. NC, OR = 0.16, 95% CI: 0.08–0.31, 95% PrI: 0.06–0.41), followed by Wei nasal jet tube (WNJT) (WNJT vs. NC, OR = 0.17, 95% CI: 0.10–0.30, 95% PrI: 0.07–0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC.
Conclusions
During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.
期刊介绍：
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.
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