Hypercarbia and high-flow nasal oxygen use during anaesthesia - risking a failure to thrive?

Autor:	Pattullo GG; North Shore Private Hospital, St. Leonards, Sydney, Australia., Culwick MD; Australian and New Zealand Tripartite Anaesthesia Data Committee, Melbourne, Australia., Endlich Y; Australian and New Zealand Tripartite Anaesthesia Data Committee, Melbourne, Australia.; The University of Adelaide, Adelaide, Australia.; Department of Anaesthesia, Royal Adelaide Hospital, Adelaide, Australia., MacPherson RD; Department of Anaesthesia and Pain Management, Royal North Shore Hospital, St. Leonards, Sydney, Australia.
Jazyk:	angličtina
Zdroj:	Anaesthesia and intensive care [Anaesth Intensive Care] 2023 Nov; Vol. 51 (6), pp. 400-407. Date of Electronic Publication: 2023 Oct 11.
DOI:	10.1177/0310057X231198257
Abstrakt:	Prevention of arterial oxygen desaturation during anaesthesia with high-flow nasal oxygen (HFNO) has gained greater acceptance for a widening range of procedures. However, during HFNO use there remains the potential for development of significant anaesthesia-associated apnoea or hypoventilation and the possibility of hypercarbia, with harmful cardiovascular or neurological sequelae. The aim of this study was to determine whether any HFNO-related hypercarbia adverse incidents had been reported on webAIRS, an online database of adverse anaesthesia-related incidents. Two relevant reports were identified of complications due to marked hypercarbia during HFNO use to maintain oxygenation. In both reports, HFNO and total intravenous anaesthesia were used during endoscopic procedures through the upper airway. In both, the extent of hypoventilation went undetected during HFNO use. An ensuing cardiac arrest was reported in one report, ascribed to acute hypercarbia-induced exacerbation of the patient's pre-existing pulmonary hypertension. In the other report, hypercarbia led to a prolonged duration of decreased level of consciousness post procedure, requiring ventilatory support. During the search, an additional 11 reports of postoperative hypercarbia-associated sedation were identified, unrelated to HFNO. In these additional reports an extended duration of severe acute hypercarbia led to sedation or loss of consciousness, consistent with the known effects of hypercarbia on consciousness. These 13 reports highlight the potential dangers of unrecognised and untreated hypercarbia, even if adequate oxygenation is maintained. Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Yasmin Endlich is the current coordinator of the webAIRS publications group. Martin Culwick is the medical director of the Australian and New Zealand Tripartite Anaesthetic Data Committee. The other authors have no conflicts of interest to declare.
Databáze:	MEDLINE
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