Transcutaneous carbon dioxide monitoring during flexible bronchoscopy under sedation: A prospective observational study

Year 2020, Volume: 4 Issue: 10, 848 - 852, 01.10.2020

Ferda Yaman , Nesimi Günal

https://doi.org/10.28982/josam.805622

Abstract

Aim: It is difficult to maintain the necessary depth of sedation during bronchoscopy, and hypoxemia, hypoventilation, and undesirable cardiovascular effects are often encountered. Transcutaneous carbon dioxide monitoring is a reliable means of detecting hypoventilation. The aim of this study was to determine the effects of transcutaneous carbon dioxide (tPCO₂) monitoring on the amount of propofol required for sedation and examine sedation-induced hypoventilation and other adverse events requiring intervention, such as stopping the procedure to ventilate during flexible bronchoscopy.
Methods: This prospective observational study included 60 patients undergoing bronchoscopy who were administered propofol. Of these, 30 patients were observed with transcutaneous carbon dioxide, and 30 were observed without. Propofol was used for sedation in all patients and the amount of propofol was compared between the groups monitored and not monitored transcutaneously for carbon dioxide. The sedation level was determined with the subjective sedation scale of the group that was not monitored.
Results: No significant differences were found between the groups in terms of propofol consumption or the number of patients who required airway interventions during the procedure (P>0.05 for both). In this observational study, the partial carbon dioxide pressure in arterial blood was measured with a transcutaneous carbon dioxide monitor, which is a non-invasive method, and the maximum carbon dioxide value measured in prolonged interventions was 85 mmHg. Hypoxia was not observed in patients who developed hypoventilation.
Conclusions: Hypoventilation is inevitable during bronchoscopy. Transcutaneous carbon dioxide monitoring may be important for high-risk cardiovascular patients.

Keywords

bronchoscopy, hypoventilation, Transcutaneous carbon dioxide, propofol, moderate sedation

Sedasyon eşliğinde fleksibl bronkoskopi sırasında transkütanöz karbondioksit monitorizasyonu: Prospektif gözlemsel çalışma

Abstract

Amaç: Bronkoskopi sırasında gerekli sedasyon derinliğini korumak zordur, hipoksemi, hipoventilasyon ve sedasyon sırasında sıklıkla istenmeyen kardiyovasküler etkilerle karşılaşılır. Transkutanöz karbondioksit monitorizasyonu, hipoventilasyonun saptanması için güvenilir bir yoldur. Bu çalışmanın amacı, transkütanöz karbondioksit (tPCO₂) takibinin sedasyon için gereken propofol miktarı üzerindeki etkilerini belirlemek ve
Sedasyona bağlı hipoventilasyon ve fleksibl bronkoskopi sırasında ventilasyon için işlemi durdurmayı gerektiren istenmeyen müdahale edilmesini gerektiren diğer olumsuz olayları incelemektir.
Yöntemler: Prospektif gözlemsel çalışmaya bronkoskopi yapılan ve propofol titrasyonu uygulanan 60 hasta dahil edildi. 30 hastaya transkütanöz karbondioksit monitörizasyonu uygulandı ve 30 hasta transkütanöz karbondioksit monitörizasyonu olmaksızın gözlendi. Tüm hastalarda sedasyon amacıyla propofol kullanıldı ve propofol miktarı transkutanöz karbondioksit ile izlenen ve izlenmeyen gruplar arasında karşılaştırıldı. Sedasyon seviyesi transkütanöz karbondioksit monitörizasyonu ile izlenmeyen grupta subjektif sedasyon skalası ile belirlendi.
Bulgular: Gruplar arasında propofol tüketiminde anlamlı fark bulunmadı. Ayrıca işlem sırasında hava yolu müdahalesi gerektiren hasta sayısı arasında anlamlı bir fark bulunmadı (P>0.05). Bu gözlemsel çalışmada arterial kan gazındaki parsiyel karbondioksit basıncı invaziv olmayan transkütanöz karbondioksit monitörü ile yapıldı ve maksimum karbondioksit değerinin 85 mmHg olduğu gözlendi. Hipoventilasyon gelişen hastalarda hipoksi görülmedi.
Sonuç: Bronkoskopi sırasında hipoventilasyon kaçınılmazdır. Transkutanöz karbondioksit monitorizasyonu, yüksek riskli hastalar için önemli olabilir.

Keywords

Bronkoskopi, Transkütanöz karbondioksit, Hipoventilasyon, Propofol, Orta düzeyde sedasyon

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