Respiratory volume monitoring reduces hypoventilation and apnea in subjects undergoing procedural sedation

Robert H. Nichols, Justin A. Blinn, Thuan M. Ho, Robert A. McQuitty, Michael Kinsky

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: The use of monitored anesthesia care for endoscopic procedures increases the risk of respiratory depression, necessitating careful monitoring of patient ventilation. We examined the effectiveness of an impedance-based respiratory volume monitor (RVM) in improving the safety of patients undergoing upper and lower gastrointestinal endoscopies under total intravenous anesthesia. We hypothesized that feedback from the RVM would allow anesthesiologists to maintain adequate ventilation, which would reduce the duration of respiratory depression (ie, hypoventilation and apnea) compared to a blinded control group. METHODS: Sixty-five subjects were enrolled in a randomized controlled trial and monitored with a noninvasive impedance-based RVM, which displayed respiratory traces and calculated expiratory minute ventilation (VE), tidal volume (VT), and breathing frequency (f) measurements. Prior to induction of anesthesia, a baseline VE measurement (VE-baseline) was taken as a measurement of normal breathing. VE was monitored throughout the procedure for signs of hypoventilation and apnea. Hypoventilation was defined as VE < 40% VE-baseline, and apneas were defined as VE-0 for > 15 s. RESULTS: Sixty-five subjects were randomly assigned to either a control (n-38) or RVM intervention group (n-27). Subjects in the intervention group had a higher VE% for the entire procedure (P-.045), as well as the third and fourth quartile of the procedure compared to the control group (P-.01). Likewise, subjects in the RVM intervention group spent significantly less time below 40% VE-baseline compared to the control group throughout the entire procedure (12 = 15% vs 32 = 24%, respectively) (P < .001). The median number of apneas per subject was greater in the control group (median 2, interquartile range 1–2, maximum 4) compared to the RVM intervention group (median 1, interquartile range 1–2, maximum 3) (P-.037). CONCLUSIONS: The control group had a higher incidence of hypoventilation and apnea compared to the RVM intervention group. Respiratory monitoring using the RVM can potentially be a useful tool for identifying early signs of respiratory depression and for titrating anesthetics to maintain adequate ventilation while minimizing patient risk. Key words: endoscopy; procedural sedation; respiratory volume monitor; ventilation monitoring. [Respir Care 2018;63(4):448 –454.

Original languageEnglish (US)
Pages (from-to)448-454
Number of pages7
JournalRespiratory Care
Volume63
Issue number4
DOIs
StatePublished - Apr 1 2018

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Hypoventilation
Apnea
Ventilation
Control Groups
Respiratory Insufficiency
Electric Impedance
Respiration
Anesthesia
Intravenous Anesthesia
Gastrointestinal Endoscopy
Tidal Volume
Physiologic Monitoring
Patient Safety
Endoscopy
Anesthetics
Randomized Controlled Trials

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Respiratory volume monitoring reduces hypoventilation and apnea in subjects undergoing procedural sedation. / Nichols, Robert H.; Blinn, Justin A.; Ho, Thuan M.; McQuitty, Robert A.; Kinsky, Michael.

In: Respiratory Care, Vol. 63, No. 4, 01.04.2018, p. 448-454.

Research output: Contribution to journalArticle

Nichols, Robert H. ; Blinn, Justin A. ; Ho, Thuan M. ; McQuitty, Robert A. ; Kinsky, Michael. / Respiratory volume monitoring reduces hypoventilation and apnea in subjects undergoing procedural sedation. In: Respiratory Care. 2018 ; Vol. 63, No. 4. pp. 448-454.
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AU - Blinn, Justin A.

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AU - Kinsky, Michael

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N2 - INTRODUCTION: The use of monitored anesthesia care for endoscopic procedures increases the risk of respiratory depression, necessitating careful monitoring of patient ventilation. We examined the effectiveness of an impedance-based respiratory volume monitor (RVM) in improving the safety of patients undergoing upper and lower gastrointestinal endoscopies under total intravenous anesthesia. We hypothesized that feedback from the RVM would allow anesthesiologists to maintain adequate ventilation, which would reduce the duration of respiratory depression (ie, hypoventilation and apnea) compared to a blinded control group. METHODS: Sixty-five subjects were enrolled in a randomized controlled trial and monitored with a noninvasive impedance-based RVM, which displayed respiratory traces and calculated expiratory minute ventilation (VE), tidal volume (VT), and breathing frequency (f) measurements. Prior to induction of anesthesia, a baseline VE measurement (VE-baseline) was taken as a measurement of normal breathing. VE was monitored throughout the procedure for signs of hypoventilation and apnea. Hypoventilation was defined as VE < 40% VE-baseline, and apneas were defined as VE-0 for > 15 s. RESULTS: Sixty-five subjects were randomly assigned to either a control (n-38) or RVM intervention group (n-27). Subjects in the intervention group had a higher VE% for the entire procedure (P-.045), as well as the third and fourth quartile of the procedure compared to the control group (P-.01). Likewise, subjects in the RVM intervention group spent significantly less time below 40% VE-baseline compared to the control group throughout the entire procedure (12 = 15% vs 32 = 24%, respectively) (P < .001). The median number of apneas per subject was greater in the control group (median 2, interquartile range 1–2, maximum 4) compared to the RVM intervention group (median 1, interquartile range 1–2, maximum 3) (P-.037). CONCLUSIONS: The control group had a higher incidence of hypoventilation and apnea compared to the RVM intervention group. Respiratory monitoring using the RVM can potentially be a useful tool for identifying early signs of respiratory depression and for titrating anesthetics to maintain adequate ventilation while minimizing patient risk. Key words: endoscopy; procedural sedation; respiratory volume monitor; ventilation monitoring. [Respir Care 2018;63(4):448 –454.

AB - INTRODUCTION: The use of monitored anesthesia care for endoscopic procedures increases the risk of respiratory depression, necessitating careful monitoring of patient ventilation. We examined the effectiveness of an impedance-based respiratory volume monitor (RVM) in improving the safety of patients undergoing upper and lower gastrointestinal endoscopies under total intravenous anesthesia. We hypothesized that feedback from the RVM would allow anesthesiologists to maintain adequate ventilation, which would reduce the duration of respiratory depression (ie, hypoventilation and apnea) compared to a blinded control group. METHODS: Sixty-five subjects were enrolled in a randomized controlled trial and monitored with a noninvasive impedance-based RVM, which displayed respiratory traces and calculated expiratory minute ventilation (VE), tidal volume (VT), and breathing frequency (f) measurements. Prior to induction of anesthesia, a baseline VE measurement (VE-baseline) was taken as a measurement of normal breathing. VE was monitored throughout the procedure for signs of hypoventilation and apnea. Hypoventilation was defined as VE < 40% VE-baseline, and apneas were defined as VE-0 for > 15 s. RESULTS: Sixty-five subjects were randomly assigned to either a control (n-38) or RVM intervention group (n-27). Subjects in the intervention group had a higher VE% for the entire procedure (P-.045), as well as the third and fourth quartile of the procedure compared to the control group (P-.01). Likewise, subjects in the RVM intervention group spent significantly less time below 40% VE-baseline compared to the control group throughout the entire procedure (12 = 15% vs 32 = 24%, respectively) (P < .001). The median number of apneas per subject was greater in the control group (median 2, interquartile range 1–2, maximum 4) compared to the RVM intervention group (median 1, interquartile range 1–2, maximum 3) (P-.037). CONCLUSIONS: The control group had a higher incidence of hypoventilation and apnea compared to the RVM intervention group. Respiratory monitoring using the RVM can potentially be a useful tool for identifying early signs of respiratory depression and for titrating anesthetics to maintain adequate ventilation while minimizing patient risk. Key words: endoscopy; procedural sedation; respiratory volume monitor; ventilation monitoring. [Respir Care 2018;63(4):448 –454.

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