Department of Thoracic Surgery, Faculty of Health, University Witten/Herdecke, Witten, Germany.
Department of Pulmology, Faculty of Health, University Witten/Herdecke, Witten, Germany.
Respiration. 2021;100(10):958-968. doi: 10.1159/000515920. Epub 2021 Apr 13.
Flexible bronchoscopy (FB) in analgosedation causes alveolar hypoventilation and hypercapnia, the more so if patients suffer from COPD. Nonetheless, neither is capnometry part of standard monitoring nor is there evidence on how long patients should be monitored after sedation.
We investigated the impact of COPD on hypercapnia during FB with endobronchial ultrasound (EBUS) in sedation and how the periprocedural monitoring should be adapted.
Two cohorts of consecutive patients - with advanced and without COPD - with the indication for FB with EBUS-guided transbronchial needle aspiration in analgosedation received continuous transcutaneous capnometry (ptcCO2) before, during, and for 60 min after the sedation with midazolam and alfentanil.
Forty-six patients with advanced COPD and 44 without COPD were included. The mean examination time was 26 ± 9 min. Patients with advanced COPD had a higher peak ptcCO2 (53.7 ± 7.1 vs. 46.8 ± 4.8 mm Hg, p < 0.001) and mean ptcCO2 (49.5 ± 6.8 vs. 44.0 ± 4.4 mm Hg, p < 0.001). Thirty-six percent of all patients reached the maximum hypercapnia after FB in the recovery room (8 ± 11 min). Patients with COPD needed more time to recover to normocapnia (22 ± 24 vs. 7 ± 11 min, p < 0.001). They needed a nasopharyngeal tube more often (28 vs. 11%, p < 0.001). All patients recovered from hypercapnia within 60 min after FB. No intermittent ventilation manoeuvres were needed.
A relevant proportion of patients reached their peak-pCO2 after the end of intervention. We recommend using capnometry at least for patients with known COPD. Flexible EBUS in analgosedation can be safely performed in patients with advanced COPD. For patients with advanced COPD, a postprocedural observation time of 60 min was sufficient.
在镇静下进行纤维支气管镜检查（FB）会导致肺泡通气不足和高碳酸血症，对于患有 COPD 的患者更是如此。然而，呼气末二氧化碳监测（capnometry）并不是标准监测的一部分，也没有关于患者在镇静后应监测多长时间的证据。
我们研究了在镇静下进行经支气管超声内镜（EBUS）引导下经支气管针吸活检时，COPD 对 FB 期间高碳酸血症的影响，以及应如何调整围手术期监测。
两个连续的患者队列——有晚期 COPD 和没有 COPD——有在镇静下进行经支气管超声内镜引导下经支气管针吸活检的适应证，在镇静前、镇静中和镇静后 60 分钟内连续接受经皮二氧化碳监测（ptcCO2），镇静药物为咪达唑仑和阿芬太尼。
共有 46 例晚期 COPD 患者和 44 例无 COPD 患者纳入研究。平均检查时间为 26±9 分钟。晚期 COPD 患者的峰值 ptcCO2 更高（53.7±7.1 与 46.8±4.8mmHg，p<0.001），平均 ptcCO2 也更高（49.5±6.8 与 44.0±4.4mmHg，p<0.001）。所有患者中有 36%在恢复室中在 FB 后达到最大高碳酸血症（8±11 分钟）。有 COPD 的患者需要更多的时间才能恢复到正常碳酸血症（22±24 与 7±11 分钟，p<0.001）。他们需要更经常使用鼻咽管（28%与 11%，p<0.001）。所有患者在 FB 后 60 分钟内都从高碳酸血症中恢复过来。不需要间歇性通气操作。
相当一部分患者在干预结束后达到了他们的最大 pCO2。我们建议对已知患有 COPD 的患者使用 capnometry。在镇静下进行柔性 EBUS 可以安全地用于患有晚期 COPD 的患者。对于晚期 COPD 患者，术后观察 60 分钟就足够了。
