Abstract
Hypoxemia can occur during endoscopic retrograde cholangiography (ERCP) and it is difficult to achieve adequate ventilation with the prone position. High-flow nasal oxygen (HFNO) has been recommended to be more effectively help ventilation than conventional low flow oxygen. The aim of this study was to evaluate the effect of HFNO during sedated ERCP and to identify predictors of desaturation during ERCP. The investigated variables were age, gender, American Society of Anesthesiologists classes (ASA), duration of exam, and sedative used for midazolam or/and propofol of 262 patients with sedated ERCP. The differences between categorical and continuous variables were analyzed using the Student’s t test and the chi-square test. Desaturation (SpO2 ≤ 90%) occurred in 9(3.4%) patients among 262 patients during sedated ERCP. The variables found to predict desaturation were older age (p < 0.01), higher sedation dose for midazolam or propofol (p < 0.01), and use of midazolam (p < 0.01). Desaturation rate was lower during sedated ERCP with HFNO compared to the preliminary study with conventional low flow nasal oxygen. Patients with older age, higher sedation dose, or the use of midazolam might require close monitoring for desaturation and hypoventilation by nursing staff. The study shows the use of high-flow nasal oxygen reduces the incidence of desaturation during ERCP.
Highlights
Abbreviations GI Gastrointestinal ERCP Endoscopic retrograde cholangiography ASA American Society of Anesthesiologists HTN Hypertension diabetes mellitus (DM) Diabetes mellitus high-flow nasal oxygen (HFNO) High-flow nasal oxygen positive end expiratory pressure” (PEEP) Positive end expiratory pressure FIO2 Fractions of inspired oxygen level of consciousness (LOC) Level of consciousness chronic destructive pulmonary disease (COPD) Chronic destructive pulmonary disease BMI Body mass index congestive heart failure (CHF) Congestive heart failure myocardial infarction (MI) Myocardial infarction coronary artery obstructive disease (CAOD) Coronary artery obstructive disease SpO2 Oxygen saturation ETCO2 End-tidal carbon dioxide common bile duct (CBD) Common bile duct ampulla of Vater (AoV) Ampulla of Vater intraductal papillary mucinous neoplasm (IPMN) Intraductal papillary mucinous neoplasm sphincter of Oddi dysfunction (SOD) Sphincter of Oddi dysfunction primary sclerosing cholangitis (PSC) Primary sclerosing cholangitis neuroendocrine tumor (NET) Neuroendocrine tumor
Records of 262 ERCP cases performed in the endoscopy suite during the 4-month period from March 2019 to June 2019 at our institution were analyzed
We investigated the effect of HFNO on desaturation events during sedated ERCP and attempted to identify predictors of desaturation
Summary
Abbreviations GI Gastrointestinal ERCP Endoscopic retrograde cholangiography ASA American Society of Anesthesiologists HTN Hypertension DM Diabetes mellitus HFNO High-flow nasal oxygen PEEP Positive end expiratory pressure FIO2 Fractions of inspired oxygen LOC Level of consciousness COPD Chronic destructive pulmonary disease BMI Body mass index CHF Congestive heart failure MI Myocardial infarction CAOD Coronary artery obstructive disease SpO2 Oxygen saturation ETCO2 End-tidal carbon dioxide CBD Common bile duct AoV Ampulla of Vater IPMN Intraductal papillary mucinous neoplasm SOD Sphincter of Oddi dysfunction PSC Primary sclerosing cholangitis NET Neuroendocrine tumor. Hypoxemia is the most common adverse cardiopulmonary complication during sedated endoscopy and is caused by respiratory depression, airway obstruction, and decreased chest wall compliance[8].
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