The effects of capnography during sedation in pediatric esophagogastroduodenoscopy procedures: A randomized controlled study

Yıl 2019, , 31 - 37, 18.09.2019

Ebru Tarıkçı Kılıç , Nelgin Gerenli

https://doi.org/10.17940/endoskopi.632022

Cited By: 1

Öz

Background and Aims: Microstream
capnography monitors are devices that use nasal sample lines to measure pulse oximeter
and end-tidal carbon dioxide values of spontaneously breathing patients.
Research suggests that capnography is a more sensitive measure of ventilation
than standard modalities. This study aimed to determine whether adding
capnography to standard monitoring improves the
detection of respiratory depression in children undergoing esophagogastroduodenoscopy
with sedation before hypoxemia occurs. Materials and Methods: We enrolled 100 children undergoing esophagogastroduodenoscopy
with sedation in a pediatric endoscopy department. All children received
standard monitoring and capnography and were randomized to study (n = 50; capnography monitor) and control (n = 50; blind to monitor) groups. The primary outcome was an oxygen
desaturation rate < 90%. Results: The control group had
higher rates of hypoventilation and oxygen desaturation
per minute and received more interventions than the study group. Untimely
interventions with hypoventilation were associated with oxygen
desaturation < 90%. All episodes of hypoventilation were due to hypopnea;
however, medication, gender, and sedation duration were not significantly
associated with this outcome. Conclusion: Hypoventilation is common
during sedation of pediatric patients undergoing
esophagogastroduodenoscopy. Capnography monitoring provides fewer but timely
interventions for apnea and hypoventilation and improves the quality of care
during sedation. We, therefore, highly recommend the use of capnography
monitoring.

Anahtar Kelimeler

Esophagogastroduodenoscopy procedures, end-tidal carbon dioxide, capnography, hypopnea, hypoventilation, airway interventions

Pediatrik özafagogastroduodenoskopi işlemlerinde sedasyon sırasında kullanılan kapnografinin etkinliği: Randomize kontrollü çalışma

Öz

Giriş
ve Amaç: Mikro-akım kapnografi, spontan soluyan hastalarda nazal
hattı ile puls oksimetre, end-tidal karbon dioksit değerlerini izlemek için
kullanılan bir cihazdır. Bugüne kadar ki kanıtlar, kapnografi kullanılmasının
standart yöntemlerden daha hassas bir ventilasyon ölçümü olduğunu
göstermektedir. Çalışmamızda, özofagogastroduodenoskopi yapılan çocukların
sedasyonu sırasında standart izlemeye kapnografi eklenmesinin hipoksemi
oluşmadan önce solunum depresyonunu tespit edip etmediğini belirlemeyi
amaçladık. Gereç ve Yöntem: Pediatrik
endoskopi bölümünde özofagogastroduodenoskopi uygulanan 100 çocuğa sedasyon
uygulandı. İşleme alınan tüm çocuklara standart monitörizasyon ve kapnografi
uygulandı ve randomizasyon ekibin kapnografi monitörünü (çalışma grubu) görüp
görmemesi veya monitöre (kontrol grubu) kör olup olmaması durumuna göre
yapıldı. Birincil sonuç, oksijen desatürasyon oranı <% 90 idi. Bulgular: Randomize olarak her gruba 50
kişi dahil edildi. Kontrol grubunda hipoventilasyon ve oksijen desatürasyon
oranı daha yüksek bulundu. Havayolu müdahale oranları çalışma grubunda kontrol
grubuna göre daha az bulundu. Hipoventilasyon ile zamanında yapılmayan
müdahaleler oksijen desatürasyonu < 90 ile ilişkilendirildi.
Tüm hipoventilasyon atakları hipopneye
bağlıydı. İlaç kullanımı, cinsiyet, sedasyon süresi bu sonuçla anlamlı olarak
ilişkili bulunmadı. Sonuç: Özofagogastroduodenoskopi
uygulanan pediatrik hastaların sedasyonu sırasında hipoventilasyon sıktır.
Kapnografi kullanımı ise apne ve hipoventilasyon durumunda sayı olarak daha az
ancak tam zamanında hava yolu müdahalesi sağlayıp, sedasyon sırasındaki
kaliteyi artırır. Kapnografi kullanılmasını kesinlikle gerekli buluyoruz.

Anahtar Kelimeler

Özafagogastroduodenoskopi işlemleri, end tidal karbondioksit, kapnografi, hipopne, hipoventilasyon, havayolu müdahaleleri

Kaynakça

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