Capnographic Monitoring of Respiratory Activity Improves Safety of Sedation for Endoscopic Cholangiopancreatography and Ultrasonography
Capnographic Monitoring of Respiratory Activity Improves Safety of Sedation for Endoscopic Cholangiopancreatography and Ultrasonography
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DOI：
10.1053/j.gastro.2009.02.004
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发表时间：
2009-05-01
期刊：
影响因子：
29.4
通讯作者：
Zuccaro, Gregory
中科院分区：
文献类型：
--
作者：
Qadeer, Mohammed A.;Vargo, John J.;Zuccaro, Gregory
背景与目的：医疗机构认证联合委员会建议在胃肠内窥镜手术镇静期间进行通气监测。我们试图确定干预是否会减少低氧血症，基于微流血糖仪的通气监测系统已被证明是低氧血症的早期预警系统。在内窥镜检查。方法：在阿片类药物和苯二氮卓类药物联合镇静下，接受选择性内窥镜逆行胆管造影（ERCP）和内窥镜超声造影（EUS）的受试者被随机分配到内镜组对造影不知情的研究组和内镜组提示造影改变的开放组。主要终点是低氧血症的发生；次要终点是严重低氧血症、呼吸暂停和补氧的发生率。结果：共纳入受试者263例；247例进行疗效分析。盲臂组和张开臂组低氧血症发生率分别为132例和69例（P < 0.001）。35%的低氧血症事件发生在完全正常通气的情况下。盲法组69%的患者出现低氧血症，而开放组为46% （P < 0.001）。盲臂组和张开臂组严重低氧血症发生率分别为31%和15% (P = 0.004)，呼吸暂停组分别为63%和41% (P < 0.001)，补氧组分别为67%和52% (P = 0.02)，补氧后再发低氧血症发生率分别为38%和18% （P = 0.01）。结论：通过减少低氧血症、严重低氧血症和呼吸暂停的频率，呼吸活动监测可提高选择性ERCP/EUS手术镇静期间患者的安全性。
Background & Aims: The joint Commission on the Accreditation of Healthcare Organizations recommends ventilation monitoring during procedural sedation for gastrointestinal endoscopy. We sought to determine whether intervention, based on a microstream capnography-based ventilation monitoring system that has been shown to function as an early warning system for hypoxemia, would decrease hypoxemia. during endoscopy. Methods: Subjects undergoing elective endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) under procedural sedation with a combination of opioid and benzodiazepine were randomly assigned to either a study arm in which the endoscopy team was blinded to capnography or an open arm in which the endoscopy team was prompted of capnographic changes. The primary end point was the occurrence of hypoxemia; secondary end points were the occurrences of severe hypoxemia, apnea, and oxygen supplementation. Results: A total of 263 subjects were enrolled; 247 were analyzed for efficacy. The numbers of hypoxemic events in the blinded and open arms were 132 and 69, respectively (P < .001). Thirty-five percent of all hypoxemic events occurred with completely normal ventilation. Hypoxemia developed in 69% of patients in the blinded arm compared with 46% in the open arm (P < .001). Severe hypoxemia percentages in the blinded and open arms were 31% and 15% (P = .004), for apnea were 63% and 41% (P < .001), for oxygen supplementation were 67% and 52% (P = .02), and for recurrent hypoxemia after oxygen supplementation were 38% and 18% (P = .01), respectively. Conclusions: Capnographic monitoring of respiratory activity improves patient safety during procedural sedation for elective ERCP/EUS by reducing the frequency of hypoxemia, severe hypoxemia, and apnea.