The Role of the Integrated Pulmonary Index in Determining Respiratory Complications in Patients Undergoing Upper Gastrointestinal Endoscopy Under Sedation
Abstract
Objective: In this study, we aimed to evaluate the respiratory complications defined by the Integrated Pulmonary Index (IPI) in patients with comorbid risk factors who underwent Upper gastrointestinal endoscopy (UGE) under sedation.
Methods: This cross-sectional, prospective study was conducted with 157 patients, aged over 18 years, in our endoscopy unit between July 2020 and December 2020. Patients’ demographic data, body mass index (BMI), ASA class and comorbidities were recorded. The mean arterial pressure (MAP), and HR, RR, SpO2, EtCO2 for the IPI were measured as baseline values and 5 minutes of the procedure and compared between two groups as the patients who developed (Group I) and did not develop (Group II) complications.
Results: The mean BMI value was statistically significantly higher in Group I compared to Group II (p<0.001). The mean HR was statistically significantly higher and IPI score significantly lower in Group I than in Group II before the procedure (p=0.013, p=0.01; respectively). The mean SpO2, EtCO2 and IPI values were statistically significantly lower in Group I compared to Group II at 5 minutes of the procedure (p=0.001, p=0.004, p=0.010; respectively). The frequency of comorbidities was statistically significantly higher in Group I. In the logistic regression analysis, BMI value was found as an independent factor affecting the development of respiratory complications.
Conclusion: The mean IPI scores dropped significantly in patients who developed complications, mainly due to the decreases in EtCO2 and SpO2 values at 5 minutes of the procedure. BMI was determined as a risk factor for the development of respiratory complications. IPI monitoring can provide guidance during sedation of patients with comorbid diseases undergoing UGE.
Methods: This cross-sectional, prospective study was conducted with 157 patients, aged over 18 years, in our endoscopy unit between July 2020 and December 2020. Patients’ demographic data, body mass index (BMI), ASA class and comorbidities were recorded. The mean arterial pressure (MAP), and HR, RR, SpO2, EtCO2 for the IPI were measured as baseline values and 5 minutes of the procedure and compared between two groups as the patients who developed (Group I) and did not develop (Group II) complications.
Results: The mean BMI value was statistically significantly higher in Group I compared to Group II (p<0.001). The mean HR was statistically significantly higher and IPI score significantly lower in Group I than in Group II before the procedure (p=0.013, p=0.01; respectively). The mean SpO2, EtCO2 and IPI values were statistically significantly lower in Group I compared to Group II at 5 minutes of the procedure (p=0.001, p=0.004, p=0.010; respectively). The frequency of comorbidities was statistically significantly higher in Group I. In the logistic regression analysis, BMI value was found as an independent factor affecting the development of respiratory complications.
Conclusion: The mean IPI scores dropped significantly in patients who developed complications, mainly due to the decreases in EtCO2 and SpO2 values at 5 minutes of the procedure. BMI was determined as a risk factor for the development of respiratory complications. IPI monitoring can provide guidance during sedation of patients with comorbid diseases undergoing UGE.
Keywords
Esophagogastroduodenoscopy, integrated pulmonary index, respiratory complications, anaesthesia, monitoring
References
- 1. Andreasen JO, Andreasen FM, Bakland LK, Flores MT. Emergency record for acute dental trauma, and clinical examination form for the time of injury and follow-up examination. Trauma Dent Inj A Manual, 2nd edn Oxford Blackwell Munksgaard. 2003;18-21. 2. Andreasen FM, Andreasen JO, Bayer T. Prognosis of root‐fractured permanent incisors—prediction of healing modalities. Dent Traumatol. 1989;5(1):11–22.
- 3. Silujjai J, Linsuwanont P. Treatment outcomes of apexification or revascularization in nonvital immature permanent teeth: a retrospective study. J Endod. 2017;43(2):238–45.
- 4. Frank AL. Therapy for the divergent pulpless tooth by continued apical formation. J Am Dent Assoc [Internet]. 1966/01/01. 1966;72(1):87–93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/5215726
- 5. Rafter M. Apexification: a review. Dent Traumatol. 2005;21(1):1–8.
- 6. Andreasen JO, Farik B, Munksgaard EC. Long‐term calcium hydroxide as a root canal dressing may increase risk of root fracture. Dent Traumatol. 2002;18(3):134–7.
- 7. Jeeruphan T, Jantarat J, Yanpiset K, Suwannapan L, Khewsawai P, Hargreaves KM. Mahidol study 1: comparison of radiographic and survival outcomes of immature teeth treated with either regenerative endodontic or apexification methods: a retrospective study. J Endod. 2012;38(10):1330–6. 8. Malkondu Ö, Kazandağ MK, Kazazoğlu E. A review on biodentine, a contemporary dentine replacement and repair material. Biomed Res Int. 2014;2014.
- 9. Torabinejad M, Chivian N. Clinical applications of mineral trioxide aggregate. J Endod. 1999;25(3):197–205.
- 10. Çiçek E, Yılmaz N, Koçak MM, Sağlam BC, Koçak S, Bilgin B. Effect of mineral trioxide aggregate apical plug thickness on fracture resistance of immature teeth. J Endod. 2017;43(10):1697–700.
- 11. Bouillaguet S, Wataha JC, Tay FR, Brackett MG, Lockwood PE. Initial in vitro biological response to contemporary endodontic sealers. J Endod. 2006;32(10):989–92.
- 12. Accardo C, Himel VT, Lallier TE. A novel GuttaFlow sealer supports cell survival and attachment. J Endod. 2014;40(2):231–4.