Jonas Aebli, Vera Bohnenblust, Gabriela Koepp-Medina, Sara Ahsani-Nasab, Markus Huber, Robert Greif, Nicola Disma, Thomas Riva, Thomas Riedel, Alexander Fuchs
{"title":"不同流量儿童在无呼吸氧合下肺容量变化：一项单中心前瞻性随机对照非劣效性试验。","authors":"Jonas Aebli, Vera Bohnenblust, Gabriela Koepp-Medina, Sara Ahsani-Nasab, Markus Huber, Robert Greif, Nicola Disma, Thomas Riva, Thomas Riedel, Alexander Fuchs","doi":"10.1111/pan.70018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>High-flow oxygen in children prolongs the apnea time. The exact mechanism remains unclear.</p><p><strong>Aims: </strong>This study investigated whether low- and high-flow nasal oxygen are non-inferior to very high-flow oxygen in preventing lung volume loss during apnoea in children under general anesthesia. We also examined whether early onset oxygen using the Optiflow Switch cannula reduces lung volume loss compared to conventional late-onset application. Finally, we assessed the timing and regional distribution of lung volume changes using electrical impedance tomography (EIT).</p><p><strong>Methods: </strong>We conducted a single center randomized controlled non-inferiority trial. After Ethics Committee approval and informed consent, we recruited 108 children (ASA1 and 2, 10-20 kg) undergoing elective general anesthesia. The primary endpoint was the normalized reduction in lung volume in relation to body weight (mL kg<sup>-1</sup>) after termination of facemask ventilation from start to end of apnoea measured with EIT. After induction of anesthesia and neuromuscular blockade, patients were left apnoeic for 5 min receiving humidified and heated oxygen with a high-flow system at different flow rates: (1) Low-flow 0.2 L min<sup>-1</sup> kg<sup>-1</sup>; (2) High-flow 2 L min<sup>-1</sup> kg<sup>-1</sup>; (3) Very high-flow 4 L min<sup>-1</sup> kg<sup>-1</sup>(control group); (4) Early onset of high-flow 2 L min<sup>-1</sup> kg<sup>-1</sup> with Optiflow Switch. Normalization of impedance change to 6-8 mL kg<sup>-1</sup> in relation to body weight and changes in lung volume from start to end of apnoea were measured.</p><p><strong>Results: </strong>89/108 children were analyzed (low-flow n = 20, high-flow n = 24, very high-flow n = 21 and early onset high-flow n = 24.). The estimated mean (95% CI) reduction in lung volume was: low-flow 5.9 (5.3-7.8) mL kg<sup>-1</sup>, high-flow 6.5 (5.3-7.8) mL kg<sup>-1</sup>, very high-flow (control) 5.7 (4.4-7.0) mL kg<sup>-1</sup>, and early onset high-flow 6.7 (5.5-7.9) mL kg<sup>-1</sup>. Non-inferiority could be demonstrated only for the low-flow group compared to the control group.</p><p><strong>Conclusions: </strong>Apnoeic oxygenation with low-flow is non-inferior to very high-flow regarding lung volume loss in children. An early onset of apnoeic oxygenation after facemask ventilation may delay lung volume loss during apnoea.</p>","PeriodicalId":19745,"journal":{"name":"Pediatric Anesthesia","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Lung Volume Change Under Apnoeic Oxygenation With Different Flow Rates in Children: A Single-Centre Prospective Randomized Controlled Non-Inferiority Trial.\",\"authors\":\"Jonas Aebli, Vera Bohnenblust, Gabriela Koepp-Medina, Sara Ahsani-Nasab, Markus Huber, Robert Greif, Nicola Disma, Thomas Riva, Thomas Riedel, Alexander Fuchs\",\"doi\":\"10.1111/pan.70018\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>High-flow oxygen in children prolongs the apnea time. The exact mechanism remains unclear.</p><p><strong>Aims: </strong>This study investigated whether low- and high-flow nasal oxygen are non-inferior to very high-flow oxygen in preventing lung volume loss during apnoea in children under general anesthesia. We also examined whether early onset oxygen using the Optiflow Switch cannula reduces lung volume loss compared to conventional late-onset application. Finally, we assessed the timing and regional distribution of lung volume changes using electrical impedance tomography (EIT).</p><p><strong>Methods: </strong>We conducted a single center randomized controlled non-inferiority trial. After Ethics Committee approval and informed consent, we recruited 108 children (ASA1 and 2, 10-20 kg) undergoing elective general anesthesia. The primary endpoint was the normalized reduction in lung volume in relation to body weight (mL kg<sup>-1</sup>) after termination of facemask ventilation from start to end of apnoea measured with EIT. After induction of anesthesia and neuromuscular blockade, patients were left apnoeic for 5 min receiving humidified and heated oxygen with a high-flow system at different flow rates: (1) Low-flow 0.2 L min<sup>-1</sup> kg<sup>-1</sup>; (2) High-flow 2 L min<sup>-1</sup> kg<sup>-1</sup>; (3) Very high-flow 4 L min<sup>-1</sup> kg<sup>-1</sup>(control group); (4) Early onset of high-flow 2 L min<sup>-1</sup> kg<sup>-1</sup> with Optiflow Switch. Normalization of impedance change to 6-8 mL kg<sup>-1</sup> in relation to body weight and changes in lung volume from start to end of apnoea were measured.</p><p><strong>Results: </strong>89/108 children were analyzed (low-flow n = 20, high-flow n = 24, very high-flow n = 21 and early onset high-flow n = 24.). The estimated mean (95% CI) reduction in lung volume was: low-flow 5.9 (5.3-7.8) mL kg<sup>-1</sup>, high-flow 6.5 (5.3-7.8) mL kg<sup>-1</sup>, very high-flow (control) 5.7 (4.4-7.0) mL kg<sup>-1</sup>, and early onset high-flow 6.7 (5.5-7.9) mL kg<sup>-1</sup>. Non-inferiority could be demonstrated only for the low-flow group compared to the control group.</p><p><strong>Conclusions: </strong>Apnoeic oxygenation with low-flow is non-inferior to very high-flow regarding lung volume loss in children. 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Lung Volume Change Under Apnoeic Oxygenation With Different Flow Rates in Children: A Single-Centre Prospective Randomized Controlled Non-Inferiority Trial.
Background: High-flow oxygen in children prolongs the apnea time. The exact mechanism remains unclear.
Aims: This study investigated whether low- and high-flow nasal oxygen are non-inferior to very high-flow oxygen in preventing lung volume loss during apnoea in children under general anesthesia. We also examined whether early onset oxygen using the Optiflow Switch cannula reduces lung volume loss compared to conventional late-onset application. Finally, we assessed the timing and regional distribution of lung volume changes using electrical impedance tomography (EIT).
Methods: We conducted a single center randomized controlled non-inferiority trial. After Ethics Committee approval and informed consent, we recruited 108 children (ASA1 and 2, 10-20 kg) undergoing elective general anesthesia. The primary endpoint was the normalized reduction in lung volume in relation to body weight (mL kg-1) after termination of facemask ventilation from start to end of apnoea measured with EIT. After induction of anesthesia and neuromuscular blockade, patients were left apnoeic for 5 min receiving humidified and heated oxygen with a high-flow system at different flow rates: (1) Low-flow 0.2 L min-1 kg-1; (2) High-flow 2 L min-1 kg-1; (3) Very high-flow 4 L min-1 kg-1(control group); (4) Early onset of high-flow 2 L min-1 kg-1 with Optiflow Switch. Normalization of impedance change to 6-8 mL kg-1 in relation to body weight and changes in lung volume from start to end of apnoea were measured.
Results: 89/108 children were analyzed (low-flow n = 20, high-flow n = 24, very high-flow n = 21 and early onset high-flow n = 24.). The estimated mean (95% CI) reduction in lung volume was: low-flow 5.9 (5.3-7.8) mL kg-1, high-flow 6.5 (5.3-7.8) mL kg-1, very high-flow (control) 5.7 (4.4-7.0) mL kg-1, and early onset high-flow 6.7 (5.5-7.9) mL kg-1. Non-inferiority could be demonstrated only for the low-flow group compared to the control group.
Conclusions: Apnoeic oxygenation with low-flow is non-inferior to very high-flow regarding lung volume loss in children. An early onset of apnoeic oxygenation after facemask ventilation may delay lung volume loss during apnoea.
期刊介绍：
Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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