A Novel Index of Hypoxemia for Assessment of Risk During Procedural Sedation

Niklewski, Paul; Phero, James C.; Martin, James F.; Lisco, Steven J.

doi:10.1213/ane.0000000000000371

Cited by 9 publications

(7 citation statements)

References 10 publications

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“…For example, if a person's oxygen saturation was 85% for a period of 30 seconds, the AUC Desat 90% for that duration was 150 (seconds %). The AUC Desat combined the incidence, duration, and magnitude of a patient's oxygen desaturation and better reflected the duration and severity of hypoxemia than the lowest saturation or the number of hypoxic events [28, 29].…”

Section: Methodsmentioning

confidence: 99%

High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial

Teng

Ting

Wang

et al. 2019

BioMed Research International

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During sedated endoscopic examinations, upper airway obstruction occurs. Nasal breathing often shifts to oral breathing during open mouth esophagogastroduodenoscopy (EGD). High-flow nasal cannula (HFNC) which delivers humidified 100% oxygen at 30 L min−1 may prevent hypoxemia. A mandibular advancement (MA) bite block with oxygen inlet directed to both mouth and nose may prevent airway obstruction during sedated EGD. The purpose of this study was to evaluate the efficacy of these airway devices versus standard management. One hundred and eighty-nine patients were assessed for eligibility. One hundred and fifty-three were enrolled. This study randomly assigned eligible patients to three arms: the standard bite block and standard nasal cannula, HFNC, and MA bite block groups. EGD was performed after anaesthetic induction. The primary endpoint was the oxygen desaturation area under curve at 90% (AUCDesat). The secondary endpoints were percentage of patients with hypoxic, upper airway obstruction, and apnoeic and rescue events. One hundred and fifty-three patients were enrolled. AUCdesat was significantly lower for HFNC and MA bite blocks versus the standard management (p= 0.019). The HFNC reduced hypoxic events by 18% despite similar airway obstruction and apnoeic events as standard group. The MA bite block reduced hypoxic events by 12% and airway obstructions by 32%. The HFNC and MA groups both showed a 16% and 14% reduction in the number of patients who received rescue intervention, respectively, compared to the standard group. The HFNC and MA bite block may both reduce degree and duration of hypoxemia. HFNC may decrease hypoxemic events while maintaining nasal patency is crucial during sedative EGD. The MA bite block may prevent airway obstruction and decrease the need for rescue intervention.

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Section: Methodsmentioning

confidence: 99%

High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial

Teng

Ting

Wang

et al. 2019

BioMed Research International

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“…Niklewski et al introduced the use of the AUC of desaturations to integrate the number, depth, and duration of oxygen desaturations. 14 By integrating these factors into one outcome measure, one might better understand the magnitude of desaturation and therefore the potential risk of the associated hypoxemia. Since the clinical importance of hypoxemia is uncertain, we displayed the dimensions of hypoxemia in our population by AUC.…”

Section: Discussionmentioning

confidence: 99%

“…To reduce the risk of artifacts possibly resulting from the sampling rate of one value per minute by the AIMS, hypoxemia was defined as oxygen saturation < 90% lasting for two or more consecutive minutes. We calculated the area under the curve (AUC) as previously shown, 14 with a small adaption in time period. For each hypoxemic event, time in minutes, magnitude of oxygen desaturation, and AUC (by multiplying duration in minutes and the drop in saturation under 90%) were determined.…”

Section: Methodsmentioning

confidence: 99%

Hypoxemia during procedural sedation in adult patients: a retrospective observational study

Schaik

Blankman

Klei

et al. 2021

Can J Anesth/J Can Anesth

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Purpose Since 2010, new guidelines for procedural sedation and the Helsinki Declaration on Patient Safety have increased patient safety, comfort, and acceptance considerably. Nevertheless, the administration of sedatives and opioids during sedation procedures may put the patient at risk of hypoxemia. However, data on hypoxemia during procedural sedation are scarce. Here, we studied the incidence and severity of hypoxemia during procedural

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“…It has been posited that surrogate outcomes must be in the causal pathway of injury with correlation alone not being sufficient [15]. A recent study reported that arterial oxygen saturation is the most important physiological parameter in assessment of risk of adverse outcomes during sedation [16]. For this reason, we determined that reduction in episodes of hypoxaemia would be the most suitable surrogate marker to investigate the potential patient safety benefits that may be associated with using DoA monitors of depth of sedation during PSA.…”

Section: Introductionmentioning

confidence: 99%

Depth of anaesthesia monitoring during procedural sedation and analgesia: a systematic review protocol

Conway

Sutherland

2015

Syst Rev

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BackgroundProcedural sedation and analgesia (PSA) is used to attenuate the pain and distress that may otherwise be experienced during diagnostic and interventional medical or dental procedures. As the risk of adverse events increases with the depth of sedation induced, frequent monitoring of level of consciousness is recommended. Level of consciousness is usually monitored during PSA with clinical observation. Processed electroencephalogram-based depth of anaesthesia (DoA) monitoring devices provide an alternative method to monitor level of consciousness that can be used in addition to clinical observation. However, there is uncertainty as to whether their routine use in PSA would be justified. Rigorous evaluation of the clinical benefits of DoA monitors during PSA, including comprehensive syntheses of the available evidence, is therefore required. One potential clinical benefit of using DoA monitoring during PSA is that the technology could improve patient safety by reducing sedation-related adverse events, such as death or permanent neurological disability. We hypothesise that earlier identification of lapses into deeper than intended levels of sedation using DoA monitoring leads to more effective titration of sedative and analgesic medications, and results in a reduction in the risk of adverse events caused by the consequences of over-sedation, such as hypoxaemia. The primary objective of this review is to determine whether using DoA monitoring during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO2] less than 90 %). Other potential clinical benefits of using DoA monitoring devices during sedation will be assessed as secondary outcomes.Methods/designElectronic databases will be systematically searched for randomized controlled trials comparing the use of depth of anaesthesia monitoring devices with clinical observation of level of consciousness during PSA. Language restrictions will not be imposed. Screening, study selection and data extraction will be performed by two independent reviewers. Disagreements will be resolved by discussion. Meta-analyses will be performed if suitable.DiscussionThis review will synthesise the evidence on an important potential clinical benefit of DoA monitoring during PSA within hospital settings.Systematic review registrationPROSPERO CRD42015017251Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0061-z) contains supplementary material, which is available to authorized users.

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A Novel Index of Hypoxemia for Assessment of Risk During Procedural Sedation

Cited by 9 publications

References 10 publications

High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial

High-Flow Nasal Cannula and Mandibular Advancement Bite Block Decrease Hypoxic Events during Sedative Esophagogastroduodenoscopy: A Randomized Clinical Trial

Hypoxemia during procedural sedation in adult patients: a retrospective observational study

Depth of anaesthesia monitoring during procedural sedation and analgesia: a systematic review protocol

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