Inadequacy of Pulse Oximetry in the Catheterization Laboratory. An Exploratory Study Monitoring Respiratory Status Using Arterial Blood Gases during Cardiac Catheterization with Conscious Sedation

Fanari, Zaher; Mohammed, Asim; Bathina, Jaya; Hodges, Desiree; Doorey, Kelsey; Gagliano, Nicholas; Garratt, Kirk N.; Weintraub, William S.; Doorey, Andrew J.

doi:10.1016/j.carrev.2018.07.027

Cited by 6 publications

(4 citation statements)

References 22 publications

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“…(Westlake, 1958) In fact, PO2 pulse oximetry does not correlate well with hypercarbia. (Fanari, 2019) Even the level of PaCO2 in and of itself is insufficient to dictate who will or will not develop CO2 narcosis symptoms, with other variables including serum bicarbonate, use of supplemental oxygen, use of opioids, and body mass index (BMI) being important variables. (Yang, 2018) However, the reports of UPE symptoms are most consistent with CO2 narcosis as an etiology.…”

Section: Co2 Narcosismentioning

confidence: 99%

Liberal Oxygen with Unreliable Unpredictable Flowrate Is the Root Cause of Unexplained Physiological Events in Combat aircraft

Bassovitch¹

2020

Preprint

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Over the last 20 years, there has been a significant increase in the number of unexplained physiological events (UPEs) reported by pilots of fighter jets across different fleets. The UPEs have resulted in grounding some types of aircraft, loss of airplanes, and even loss of life. Despite considerable research, no single agreed-upon root cause has been found that explains UPEs, and therefore no reliable corrective actions exist. The purpose of this review was to analyze the literature related to other industries in which artificial hyperoxic gas mixes are employed and similar adverse reports have been reported. Based on analysis of the literature, it is hypothesized that UPEs are caused by unlimited delivery of high-dose oxygen in excess of officially approved oxygen schedules in the presence of inadequate airflow rates, at a time when the positive pressure breathing feature of their oxygen regulator system is not used. During flight maneuvers such as climbs, turns, and descents, pulmonary vital capacity is impaired by G-maneuvers and oxygen- and G-induced atelectasis. At the same time, tidal volume is reduced by flight gear, and effective gas exchange is not supported by adequate ventilation. These factors combine to produce hypercarbia, respiratory acidosis, acute respiratory distress syndrome, CO2 narcosis, and coma. In fact, reports from field data related to incidents in F-18S/H, showing that emergency oxygen did not correct the hypoxia-like symptoms including long-lasting periods of incapacitation and prolonged headaches, lend support to this hypothesis.

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Section: Co2 Narcosismentioning

confidence: 99%

Liberal Oxygen with Unreliable Unpredictable Flowrate Is the Root Cause of Unexplained Physiological Events in Combat aircraft

Bassovitch¹

2020

Preprint

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“…[47] In fact, PO2 pulse oximetry similarly does not correlate well with hypercarbia. [15] Even the level of PaCO2 in and of itself is insufficient to dictate who will or will not develop CO2 narcosis symptoms, with other variables including serum bicarbonate, use of supplemental oxygen, use of opioids, and BMI being important. [48] However Researchers should abandon the pervasive dogma of "hyperoxia-induced hypocapnia".…”

Section: Co2 Narcosis As the Cause Of Upesmentioning

confidence: 99%

CO<sub>2</sub> Narcosis as a Root Cause of Unexplained Physiological Events in High Performance Aircraft

Bassovitch¹

2020

Preprint

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Since 1991, there has been an alarming increase in the number of unexplained physiological events (UPEs) reported and experienced by pilots of jet fighters across different fleets. The UPEs have resulted in grounding some airframes, loss of aircraft, and even loss of life. There is no single agreed-upon root cause of UPEs that has been identified, and therefore there is no reliable corrective action. This author analyzed the literature related to other industries where artificial hyperoxic gas mixes are employed and where similar adverse reports have been reported. I hypothesize that UPEs are caused by high-dose oxygen delivery in excess of officially approved oxygen schedules while airflow rates are often inadequate, at a time when the positive pressure breathing feature of their oxygen regulator is not used. In a setting where pulmonary vital capacity is adversely affected by G-maneuvers and oxygen- and G-induced atelectasis, tidal volume is reduced by flight gear, and effective gas exchange is not supported by adequate ventilation, these factors combine to produce respiratory acidosis, followed by acute respiratory distress syndrome, CO2 narcosis, and coma. Reports from field data related to incidents in F-18S/H, showing that emergency oxygen did not correct the hypoxia-like symptoms including long-lasting periods of incapacitation and prolonged headaches, lend support to our hypothesis.

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“…A study by Fanari et al (2019) noted that hypoxia, as indicated by a drop in SpO 2 , was seen in 22% of the 18 patients investigated for the effects of sedation on arterial blood gases. These authors felt that supplemental oxygen increased the risk for hypoventilation due to the “false assurance” (p. 6) of a SpO 2 value within a normal range.…”

Section: Introductionmentioning

confidence: 99%

Identifying Predictors of Airway Complications During Conscious Sedation Procedures

Bray

Knapp

2021

Gastroenterology Nursing

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Conscious sedation procedures are complicated by unanticipated airway compromise and obstruction. The STOP-Bang questionnaire (University of Toronto, 2012) is a validated obstructive sleep apnea screening questionnaire used as a preprocedure evaluation tool to assess a patient's risk for obstructive sleep apnea. The purpose of this study was to determine whether risk factors for obstructive sleep apnea, using the STOP-Bang questionnaire, could predict procedural airway complications in 152 endoscopy patients following conscious sedation. Logistic regression analysis revealed that a STOP-Bang score of greater than 5 (high risk) predicted a 10% change in heart rate (p = .021), apnea (p = .038), and arousal-relieved airway obstruction (p = .023). Every point of increase in body mass index predicted a 10% change in heart rate (p = .046), a drop in oxygen saturation (p = .002), apnea (p = .003), and 1.212 times the odds of requiring arousal-relieved airway obstruction (p = .002). An intermediate-risk STOP-Bang score (3-4) positively correlated to abnormal carbon dioxide values during the procedure (p = .015). These findings concur with existing literature on the topic and translate to clinical considerations of procedural monitoring protocols for patients with a high probability for airway complications during conscious sedation.

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Inadequacy of Pulse Oximetry in the Catheterization Laboratory. An Exploratory Study Monitoring Respiratory Status Using Arterial Blood Gases during Cardiac Catheterization with Conscious Sedation

Cited by 6 publications

References 22 publications

Liberal Oxygen with Unreliable Unpredictable Flowrate Is the Root Cause of Unexplained Physiological Events in Combat aircraft

Liberal Oxygen with Unreliable Unpredictable Flowrate Is the Root Cause of Unexplained Physiological Events in Combat aircraft

CO<sub>2</sub> Narcosis as a Root Cause of Unexplained Physiological Events in High Performance Aircraft

Identifying Predictors of Airway Complications During Conscious Sedation Procedures

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