Kim Seung Hyun, Park Minsu, Lee Jinae, Kim Eungjin, Choi Yong Seon
Department of Anesthesiology and Pain Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.
Ther Clin Risk Manag. 2018 Sep 6;14:1605-1614. doi: 10.2147/TCRM.S174698. eCollection 2018.
The use of capnography monitoring devices has been shown to lower the rates of hypoxemia via early detection of respiratory depression, and facilitate more accurate titration of sedatives during procedures. The aim of the current meta-analysis was to compare the incidence of hypoxemia associated with standard monitoring alone during gastrointestinal endoscopy to that associated with standard monitoring with the addition of capnography.
The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials scientific databases were searched to identify relevant studies. We performed a meta-analysis of randomized controlled trials undertaken up to January 2018 that met our predefined inclusion criteria. The study outcome measures were incidence of hypoxemia, severe hypoxemia, apnea, the use of assisted ventilation, the use of supplemental oxygen, and change in vital signs.
We included nine trials assessing a total of 3,088 patients who underwent gastrointestinal procedural sedation. Meta-analysis of study outcome revealed that capnography significantly reduced the incidence of hypoxemia (odds ratio 0.61, 95% CI 0.49-0.77) and severe hypoxemia (odds ratio 0.53, 95% CI 0.35-0.81). However, there were no significant differences in other outcomes including incidence of apnea, assisted ventilation, supplemental oxygen, and changes in vital signs. Early procedure termination and patient satisfaction-related outcomes did not differ significantly in the capnography group and the standard monitoring group.
This study indicates that capnography monitoring is an important addition with regard to the detection of hypoxemia during gastrointestinal procedural sedation, and should be considered in routine monitoring during gastrointestinal endoscopy.
二氧化碳图监测设备的使用已被证明可通过早期发现呼吸抑制来降低低氧血症的发生率，并有助于在操作过程中更准确地滴定镇静剂。本荟萃分析的目的是比较在胃肠内镜检查期间仅采用标准监测与采用标准监测并加用二氧化碳图监测时低氧血症的发生率。
检索MEDLINE、EMBASE和Cochrane对照试验中央注册库等科学数据库以识别相关研究。我们对截至2018年1月进行的符合我们预先定义纳入标准的随机对照试验进行了荟萃分析。研究结局指标包括低氧血症、严重低氧血症、呼吸暂停的发生率，辅助通气的使用情况，补充氧气的使用情况以及生命体征的变化。
我们纳入了9项试验，共评估了3088例接受胃肠操作镇静的患者。对研究结局的荟萃分析显示，二氧化碳图显著降低了低氧血症的发生率（比值比0.61，95%可信区间0.49 - 0.77）和严重低氧血症的发生率（比值比0.53，95%可信区间0.35 - 0.81）。然而，在其他结局方面，包括呼吸暂停的发生率、辅助通气、补充氧气以及生命体征的变化，均无显著差异。二氧化碳图监测组和标准监测组在早期操作终止和患者满意度相关结局方面无显著差异。
本研究表明，二氧化碳图监测对于胃肠操作镇静期间低氧血症的检测是一项重要补充，在胃肠内镜检查的常规监测中应予以考虑。
