Effect of reverse Trendelenburg position and positive pressure ventilation on safe non-hypoxic apnea period in obese, a randomized-control trial

BMC Anesthesiology

Research

Etienne J. Couture¹  Issam Tanoubi²  Antony Carrier-Boucher³  Jean S. Bussières⁴  Steeve Provencher⁵  Simon Marceau⁶ 

[1] Department of Anesthesiology and Critical Care, Laval University, Quebec, Canada;Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval, 2725, Chemin Sainte-Foy, G1V 4G5, Québec, QC, Canada;Department of Anesthesiology, Centre Intégré Universitaire de Santé Et de Services Sociaux de L’Est-de-L’Île-de-Montréal, University of Montreal Medical Simulation Center (CAAHC), Montréal, Canada;Department of Anesthesiology, Hôpital Sacré-Cœur, CIUSSS Nord de L’Île de Montréal, Montréal, Canada;Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec – Université Laval, 2725, Chemin Sainte-Foy, G1V 4G5, Québec, QC, Canada;Department of Pneumology, Institut Universitaire de Cardiologie et de Pneumologie de Québec– Université Laval, Quebec, Canada;Department of Surgery, Institut Universitaire de Cardiologie , et de Pneumologie de Québec – Université Laval, Quebec, Canada;

关键词: Preoxygenation;    Positioning;    Obesity;    Safety;    Positive Pressure;   

DOI  :  10.1186/s12871-023-02128-7

 received in 2022-10-23, accepted in 2023-05-07,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeThere is an elevated incidence of hypoxemia during the airway management of the morbidly obese. We aimed to assess whether optimizing body position and ventilation during pre-oxygenation allow a longer safe non-hypoxic apnea period (SNHAP).MethodsFifty morbidly obese patients were recruited and randomized for this study. Patients were positioned and preoxygenated for three minutes in the ramp position associated with spontaneous breathing without additional CPAP or PEEP (RP/ZEEP group) or in the reverse Trendelenburg position associated with pressure support ventilation mode with pressure support of 8 cmH2O and an additional 10 cmH2O of PEEP while breathing spontaneously (RT/PPV group) according to randomization.ResultsThe SNHAP was significantly longer in the RT/PPV group (258.2 (55.1) vs. 216.7 (42.3) seconds, p = 0.005). The RT/PPV group was also associated to a shorter time to obtain a fractional end-tidal oxygen concentration (FEtO2) of 0.90 (85.1(47.8) vs 145.3(40.8) seconds, p < 0.0001), a higher proportion of patients that reached the satisfactory FEtO2 of 0.90 (21/24, 88% vs. 13/24, 54%, p = 0.024), a higher FEtO2 during preoxygenation (0.91(0.05) vs. 0.89(0.01), p = 0.003) and a faster return to 97% oxygen saturation after ventilation resumption (69.8 (24.2) vs. 91.4 (39.2) seconds, p = 0.038).ConclusionIn the morbidly obese population, RT/PPV, compared to RP/ZEEP, lengthens the SNHAP, decreases the time to obtain optimal preoxygenation conditions, and allows a faster resuming of secure oxygen saturation. The former combination allows a more significant margin of time for endotracheal intubation and minimizes the risk of hypoxemia in this highly vulnerable population.Trial registrationNCT02590406, 29/10/2015.

【 授权许可】

CC BY   
© The Author(s) 2023

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