O'Brien-Lambert Alex, Driver Brian, Moore Johanna C, Schick Alexandra, Miner James R
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN.
Acad Emerg Med. 2016 Jan;23(1):98-101. doi: 10.1111/acem.12843. Epub 2015 Dec 31.
The objective was to assess whether respiratory depression and supportive airway measures occurring during procedural sedation are associated with changes in peripheral tissue oxygen saturation (StO2 ).
This was a prospective observational study of adult patients undergoing procedural sedation in the emergency department (ED). Patients undergoing sedation with propofol, 1:1 propofol and ketamine, and 4:1 propofol and ketamine were included. Clinical interventions, sedative medication doses, vital signs, end-tidal capnography (ETCO2 ), pulse oximetry (SpO2 ), and peripheral tissue oxygen saturation (StO2 ) were recorded. Respiratory depression was defined as the occurrence of a recorded SpO2 < 92%, an increase in ETCO2 > 10 mm Hg from baseline, or loss of capnography waveform. Supportive airway measures documented during the procedure included bag-valve mask ventilation, airway repositioning maneuvers, increase in supplemental oxygen, and stimulation to induce respiration. Relative changes in StO2 between baseline and nadir were compared among patients who met respiratory depression criteria or required a supportive airway measure and those who did not.
Ninety-three patients were enrolled. Thirty-two patients (34.4%) met criteria for respiratory depression, and 31 (33.3%) required intervention in the form of a supportive airway measure. The median percent change in StO2 from procedure baseline to nadir in patients meeting criteria for respiratory depression was 13.6%, compared to 4.2% in those who did not. The change in StO2 in patients who required a supportive airway measure was 12.5% versus 5.4% in those who did not.
Patients with respiratory depression and the use of supportive airway measures had greater changes in StO2 during procedural sedation than in patients who did not. Peripheral tissue oxygen saturation monitoring may be a useful tool for assessing respiratory adverse events in patients undergoing procedural sedation in the ED.
评估在程序性镇静期间发生的呼吸抑制和支持性气道措施是否与外周组织氧饱和度（StO2）的变化相关。
这是一项对急诊科（ED）接受程序性镇静的成年患者进行的前瞻性观察性研究。纳入使用丙泊酚、丙泊酚与氯胺酮1:1混合制剂以及丙泊酚与氯胺酮4:1混合制剂进行镇静的患者。记录临床干预措施、镇静药物剂量、生命体征、呼气末二氧化碳监测（ETCO2）、脉搏血氧饱和度（SpO2）和外周组织氧饱和度（StO2）。呼吸抑制的定义为记录到的SpO2 < 92%、ETCO2较基线升高> 10 mmHg或二氧化碳监测波形消失。记录的在操作过程中采取的支持性气道措施包括袋阀面罩通气、气道重新定位操作、增加补充氧气以及刺激诱导呼吸。比较符合呼吸抑制标准或需要支持性气道措施的患者与未出现上述情况的患者在基线和最低点之间StO2的相对变化。
共纳入93例患者。32例患者（34.4%）符合呼吸抑制标准，31例（33.3%）需要采取支持性气道措施进行干预。符合呼吸抑制标准的患者从操作基线到最低点StO2的中位百分比变化为13.6%，而未出现呼吸抑制的患者为4.2%。需要支持性气道措施的患者StO2的变化为12.5%，未采取该措施的患者为5.4%。
与未出现呼吸抑制的患者相比，出现呼吸抑制并采取支持性气道措施的患者在程序性镇静期间StO2的变化更大。外周组织氧饱和度监测可能是评估急诊科接受程序性镇静患者呼吸不良事件的有用工具。
