Ventilation monitoring during moderate sedation in GI patients

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• 作者：Thomas J. Ebert ; Austin H. Middleton…
• 关键词：End ; tidal CO2 ; Minute ventilation ; Conscious sedation ; Monitored anesthesia care
• 刊名：Journal of Clinical Monitoring and Computing
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：31
• 期：1
• 页码：53-57
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：Anesthesiology; Intensive / Critical Care Medicine; Statistics for Life Sciences, Medicine, Health Sciences;
• 出版者：Springer Netherlands
• ISSN：1573-2614
• 卷排序：31

文摘

Sedation in locations outside the operating room (OR) is common. Guidelines for safe patient monitoring have been updated by the American Society of Anesthesiology to include monitoring of ventilation and/or carbon dioxide (CO₂). Although technologies exist to monitor these variables, the quality and/or availability of these measurements in non-OR settings is not optimal. This quality improvement project assessed the value of impedance technology for monitoring minute ventilation (MV) compared to standard end-tidal monitoring of CO₂ (ETCO₂). Patients undergoing GI exams with moderate sedation provided by anesthesia providers were monitored for MV with a respiratory volume monitor (ExSpiron 1Xi, Respiratory Motion, Waltham, MA) and ETCO₂ via nasal cannula (NC). Calibration and baseline data were collected prior to sedation. Continuous MV and ETCO₂ data were collected and averaged, providing minute values after sedation medications throughout the procedure. Stable periods of reduced MV were averaged and used in comparison to ETCO₂. Data from 20 patients were evaluated. After sedation, the expected decrease in MV after sedation was observed in 18 of 20 patients (average −47.82 %), while an increase in ETCO₂ was observed in just 10 of 20 patients (average −5.17 mm Hg). The correlation coefficient between changes in MV and ETCO₂ in response to sedation administration was positive and not significant, r = 0.223. Ventilation monitoring may provide an element of safety for earlier and more reliable detection of reduced ventilation compared to a surrogate for hypoventilation, ETCO₂, in patients undergoing sedation for GI procedures outside of the OR.