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

Abstract

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.

Keywords

• 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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