Helgeson Scott A, Lewis Kristyn L, Carter Laurel E, Saunders Hollie, Patel Neal M
Department of Pulmonary Medicine, Mayo Clinic, Jacksonville, FL, USA.
Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA.
Lung India. 2020 Sep-Oct;37(5):407-410. doi: 10.4103/lungindia.lungindia_74_20.
Carbon dioxide (CO) insufflation for endoscopies has been shown to be more comfortable and safe, but only in patients without underlying chronic obstructive pulmonary disease (COPD). The aim of this study was to show that using CO is safe in COPD patients.
Patients were retrospectively identified who underwent extended endoscopic procedures during the time period of January 2012 to December 2017. Patients were included if they also had COPD. A matched control group without COPD was created during the same timeframe. All the patients were sedated with continuous monitoring of their CO levels by end-tidal CO (EtCO).
One hundred and ten patients had COPD and underwent an extended endoscopic procedure. These patients had a higher severity of their comorbidities (American Society of Anesthesiologists class 3 or 4) (93.6% [95% confidence interval [CI], 87.4%-96.9%] vs. 60.3% [95% CI, 51.1%-69.0%]; P < 0.01) and an increase of co-existing obstructive sleep apnea (33.6% vs. 6.3%, P < 0.01). There was no difference in baseline EtCO, but the peak EtCO and postprocedure EtCO were both significantly higher in the COPD group. The only postprocedural complication found was an inability to be extubated immediately following the procedure with subsequent need to hospitalize the patient, which occurred in three patients (2.8%; 95% CI, 0.9%-7.9%) in the COPD group and one (0.9%; 95% CI, 0.2%-4.9%) in the non-COPD group (P = 0.37).
The present study, which was the only study looking at CO insufflation specifically in COPD patients, provides evidence that CO insufflation is safe in COPD despite a slight increase in EtCO.
已证明用于内镜检查的二氧化碳（CO₂）注入更舒适且安全，但仅适用于无潜在慢性阻塞性肺疾病（COPD）的患者。本研究的目的是表明在COPD患者中使用CO₂是安全的。
回顾性确定2012年1月至2017年12月期间接受延长内镜手术的患者。如果患者同时患有COPD则纳入研究。在同一时间段内创建了一个无COPD的匹配对照组。所有患者均接受镇静，并通过呼气末CO₂（EtCO₂）持续监测其CO₂水平。
110例患有COPD的患者接受了延长内镜手术。这些患者的合并症严重程度更高（美国麻醉医师协会3或4级）（93.6%[95%置信区间[CI]，87.4%-96.9%]对60.3%[95%CI，51.1%-69.0%]；P<0.01），并存阻塞性睡眠呼吸暂停的发生率增加（33.6%对6.3%，P<0.01）。基线EtCO₂无差异，但COPD组的EtCO₂峰值和术后EtCO₂均显著更高。术后发现的唯一并发症是术后无法立即拔管，随后需要住院治疗，COPD组有3例患者发生（2.8%；95%CI，0.9%-7.9%），非COPD组有1例患者发生（0.9%；95%CI，0.2%-4.9%）（P=0.37）。
本研究是唯一专门针对COPD患者进行CO₂注入的研究，提供了证据表明尽管EtCO₂略有升高，但在COPD患者中CO₂注入是安全的。
