Efficiency and safety of nasal positive airway pressure systems during endoscopic procedures in high risk patients. Endo-Breath-Study

Aims Sedation of high-risk patients resemble a relevant issue in interventional endoscopy. This especially because standard oxymetric monitoring displays only hypoxia and not the preceding hypercapnia. Therefore, the question arises whether the implication of a nasal positive airway pressure (nPAP) system can decrease the rate of sedation associated events.

Methods A randomised, prospective trial, was conducted at University Hospital Ulm, including 110 consecutive patients, identified as high-risk patients (ASA physical status ≥ 3) and scheduled for prolonged (>15 minutes) endoscopic procedures. Patients underwent 1:1 randomisation into interventional (nPAP-mask) and control (conventional oxygen supplementation) group. Levels of CO² were measured non-invasively by transcutaneous capnometry device. Primary outcome was the incidence of hypoxia (SpO2<90%) and difference between initial and mean CO² levels (ΔCO²).

Results Data-analysis of currently fully processed 42 out of 110 cases showed lower incidence of hypoxia in interventional group (0/21 vs. 6/21) p< 0.05. In 3 out those 6 patients, episodes of severe hypoxia (SpO²<80%) were detected. There was a noticeable difference in ΔCO² levels in interventional vs. control group (3.48 (± 8.43) vs. 7.59(±7.13) mmHg).

Conclusions In high-risk patients a nasal positive airway pressure system could significantly lower the risk of hypoxia especially in prolonged procedures. It has also shown to reduce possibility of hypercarbia during endoscopic procedures so far.

 

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Conflicts of interest

Authors do not have any conflict of interest to disclose.

Publikationsverlauf

Artikel online veröffentlicht:
14. April 2023