Combined Pulse Oximetry/Cutaneous Carbon Dioxide Tension Monitoring during Colonoscopies: Pilot Study with a Smart Ear Clip

Heuss, Ludwig T.; Chhajed, Prashant N.; Schnieper, Patricia; Hirt, Thomas; Beglinger, Christoph

doi:10.1159/000081515

Cited by 31 publications

(16 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies have looked at the use of capnography monitoring in children and adults, and, specifically in gastrointestinal procedures, have shown an additional value over pulse oximetry [2,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children

Garah

Adiv

Rosen

et al. 2015

J Clin Monit Comput

View full text Add to dashboard Cite

The Integrated Pulmonary Index (IPI) is an algorithm included in commercially available monitors that constitutes a representation of 4 parameters: EtCO2, RR, SpO2 and PR. The IPI index has been validated for adults and children older than 1 year of age. In this study we aimed to study the value of IPI monitoring during pediatric endoscopic procedures. Our data consisted of 124 measurements of 109 patients undergoing different procedures (upper endoscopy 84 patients, colonoscopy 6 patients, both 9 patients). The data was divided into 3 groups based on the drug type used: propofol only, 5 patients (group 1); propofol & midazolam, 89 patients (group 2); propofol, midazolam and Fentanyl, 15 patients (group 3). Patients in group 2 and 3 had significantly higher IPI levels than group 1. Significantly lower IPI values were found between ages 4-6 compared to 7-12 years old. High midazolam dose was associated with lower IPI levels during the procedure. No significant differences were found for propofol doses. Patients who had an anesthetist present had lower IPI levels during the procedure compared to those who did not. No differences were noted between the different procedures. IPI alerted all apnea episodes (58 events, IPI = 1) and hypoxia (26 events, IPI ≤ 3) episodes, whereas pulse oximetry captured only the hypoxia episodes (IPI sensitivity = 1, specificity 0.98, positive predictive value 0.95). Younger patient age, use of propofol alone, higher midazolam doses and presence of anesthetist are all associated with lower IPI levels.

show abstract

Section: Introductionmentioning

confidence: 99%

The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children

Garah

Adiv

Rosen

et al. 2015

J Clin Monit Comput

View full text Add to dashboard Cite

show abstract

“…Studies report a good correlation of PcCO 2 values with arterial blood gas measurements [16,17,18,19]. Similar to medical thoracoscopy and colonoscopy, bronchoscopy is also associated with an increase in PcCO 2 [17,19,20]. …”

Section: Introductionmentioning

confidence: 99%

Propofol Safety in Bronchoscopy: Prospective Randomized Trial Using Transcutaneous Carbon Dioxide Tension Monitoring

Carmi

Kramer²,

Zemtzov³

et al. 2011

Respiration

View full text Add to dashboard Cite

Background: Midazolam is commonly used for sedation during flexible bronchoscopy because of its relatively wide therapeutic window. Recently, sedation with propofol for bronchoscopy has gained popularity, although concern has been raised regarding its potential ability to induce severe respiratory depression. Objectives: The aim of this study was to evaluate the safety of sedation under midazolam + alfentanil compared to propofol. Methods: We conducted a prospective randomized trial using continuous transcutaneous carbon dioxide tension monitoring. The study group included 115 patients undergoing bronchoscopy, prospectively randomized to receive sedation with either midazolam + alfentanil (n = 59) or propofol (n = 56). Results: Intra-procedural carbon dioxide tension values were higher in the midazolam + alfentanil group than in the propofol group (maximum 53.72 vs. 49.49 mm Hg, mean 46.78 vs. 43.78 mm Hg), but the differences did not reach statistical significance (p = 0.149 and 0.193, respectively). Carbon dioxide tension values were significantly higher in the midazolam + alfentanil group than in the propofol group at 5 and 10 min following procedure (51.7 vs. 49.3 mm Hg, p = 0.026, and 50.8 vs. 42.7 mm Hg, p < 0.01, respectively), and significantly more patients in the midazolam + alfentanil group needed oxygen supplementation or airway support (24 vs. 8 patients, respectively). Conclusion: Midazolam + alfentanil and propofol are equally safe for sedation during bronchoscopy. Sedation with propofol, using small boluses at short intervals, does not cause excessive respiratory drive depression and represents an excellent alternative to traditional sedation agents.

show abstract

“…In intubated patients or patients under stable conditions without oral leakage, end-tidal carbon dioxide tension has a good correlation with Pa,CO 2 [9,10]. However, during endoscopy procedures under sedation, regular breathing is often disturbed by moving, coughing or changes between nose and mouth ventilation, causing leakage and artefacts or misinterpretation of the data acquired with end-tidal carbon dioxide measurements.…”

mentioning

confidence: 99%

“…However, during endoscopy procedures under sedation, regular breathing is often disturbed by moving, coughing or changes between nose and mouth ventilation, causing leakage and artefacts or misinterpretation of the data acquired with end-tidal carbon dioxide measurements. These problems often restrict the use of side-stream capnography in clinical practice [10]. Measurement of cutaneous carbon dioxide tension (Pc,CO 2 ) with a digital sensor has recently been reported [11].…”

mentioning

confidence: 99%

“…The Pc,CO 2 values have been shown to have a good correlation with arterial blood gas measurements [12,13]. A rise in Pc,CO 2 measurement has been reported during medical thoracoscopy and colonoscopies [10,13]. The present authors aimed to assess the feasibility of measuring combined pulse oximetry (Sp,O 2 ) and Pc,CO 2 at the ear lobe to monitor ventilation and quantify the degree of change in Pc,CO 2 during flexible bronchoscopy under local anaesthesia and sedation.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Measurement of combined oximetry and cutaneous capnography during flexible bronchoscopy

Chhajed

Rajasekaran²,

Kaegi³

et al. 2006

European Respiratory Journal

View full text Add to dashboard Cite

The aim of the present study was to assess the feasibility of measuring combined arterial oxygen saturation measured by pulse oximetry (Sp,O 2 ) and cutaneous carbon dioxide tension (Pc,CO 2 ) to monitor ventilation and quantify change in Pc,CO 2 during bronchoscopy.Combined Sp,O 2 and Pc,CO 2 were measured at the ear lobe in 114 patients. In four patients, the ear-clip slipped and they were excluded. In total, 11 patients had artefacts with Sp,O 2 recordings, thus, Sp,O 2 was analysed in 99 patients. Spirometry data were available in 77 patients. Multivariate analysis of covariance and logistic regression were used for statistical analyses.Mean baseline Pc,CO 2 was 4.78¡1.06 kPa (36¡8 mmHg) and mean rise in the Pc,CO 2 during bronchoscopy was 1.26¡0.70 kPa (9.5¡5.3 mmHg), while mean Pc,CO 2 at the end of bronchoscopy was 5.85¡1.19 kPa (44¡9 mmHg) . Baseline Pc,CO 2 and the lowest Sp,O 2 were significantly associated with peak Pc,CO 2 and the change in Pc,CO 2 during bronchoscopy. Risk of significant hypoxaemia (Sp,O 2 f90%) was lower for a higher baseline Sp,O 2 . Peak Pc,CO 2 was directly associated with significant hypoxaemia. There was no significant association in the baseline Pc,CO 2 , peak Pc,CO 2 , baseline Sp,O 2 or the lowest Sp,O 2 comparing patients with and without chronic obstructive pulmonary disease.In conclusion, it is feasible to measure combined pulse oximetry and cutaneous carbon dioxide tension effectively to monitor ventilation during flexible bronchoscopy.

show abstract

Combined Pulse Oximetry/Cutaneous Carbon Dioxide Tension Monitoring during Colonoscopies: Pilot Study with a Smart Ear Clip

Cited by 31 publications

References 42 publications

The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children

The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children

Propofol Safety in Bronchoscopy: Prospective Randomized Trial Using Transcutaneous Carbon Dioxide Tension Monitoring

Measurement of combined oximetry and cutaneous capnography during flexible bronchoscopy

Contact Info

Product

Resources

About