Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Gastrocentro, Campinas, SP, Brasil.
Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Disciplina de Pneumologia, Campinas, SP, Brasil.
Arq Gastroenterol. 2022 Jul-Sep;59(3):383-389. doi: 10.1590/S0004-2803.202203000-69.
Capnography and carbon dioxide (CO2) insufflation during gastrointestinal endoscopy under sedation are associated with safety and comfort improvements, respectively. Capnography can provide early detection of apnea and hypoxemia, whereas CO2 insufflation causes lower periprocedural discomfort. This is the first study to report the application of volumetric capnography in colonoscopy.
This study aimed to evaluate the use of volumetric capnography with room air (RA) and CO2 insufflation during routine colonoscopy.
In this prospective cohort study, 101 patients who underwent routine colonoscopy under sedation with volumetric capnography monitoring were included. Insufflation with RA was used to distend the intestinal lumen in group 1 (n=51), while group 2 (n=50) used CO2 insufflation. The primary endpoints were episodes of hypoxia, alveolar hypoventilation, and end-tidal CO2 (EtCO2). The secondary endpoints were tidal volume per minute, consumption of sedation medications, and post-procedure pain using the Gloucester modified pain scale.
The number of episodes of hypoxia (SpO2<90%) was similar between the groups: four episodes in Group 1 and two episodes in Group 2. The duration of hypoxia was significantly longer in group 2 (P=0.02). Hypoalveolar ventilation (EtCO2) occurred more frequently in Group 2 than in Group 1 (27 vs 18 episodes, P=0.05). Regarding EtCO2, Group 2 showed higher values in cecal evaluation (28.94±4.68 mmHg vs 26.65±6.12 mmHg, P=0.04). Regarding tidal volume per minute, Group 2 had significantly lower values at the cecal interval compared to Group 1 (2027.53±2818.89 vs 970.88±1840.25 L/min, P=0.009). No episodes of hypercapnia (EtCO2 > 60 mmHg) occurred during the study. There was no difference in the consumption of sedation medications between the groups. Immediately after colonoscopy, Group 2 reported significantly less pain than Group 1 (P=0.05).
In our study, volumetric capnography during colonoscopy was feasible and effective for monitoring ventilatory parameters and detecting respiratory complications. CO2 insufflation was safe and associated with less pain immediately after colonoscopy.
在镇静下进行胃肠内镜检查时，二氧化碳（CO2）充气和呼气末二氧化碳（EtCO2）监测分别与安全性和舒适度的改善相关。EtCO2 监测可早期发现呼吸暂停和低氧血症，而 CO2 充气则会导致操作过程中不适程度降低。这是首次报告在结肠镜检查中应用容量法 EtCO2 监测的研究。
本研究旨在评估在常规结肠镜检查中使用容量法 EtCO2 监测与空气（RA）和 CO2 充气的效果。
在这项前瞻性队列研究中，纳入了 101 例行镇静下常规结肠镜检查并进行容量法 EtCO2 监测的患者。在组 1（n=51）中使用 RA 充气来扩张肠腔，在组 2（n=50）中使用 CO2 充气。主要终点为缺氧、肺泡通气不足和 EtCO2 事件。次要终点为分钟潮气量、镇静药物的使用量和使用格洛斯特改良疼痛量表评估的检查后疼痛。
两组患者缺氧（SpO2＜90%）的发作次数相似：组 1 有 4 次发作，组 2 有 2 次发作。组 2 缺氧持续时间明显更长（P=0.02）。组 2 的低肺泡通气（EtCO2）发作频率高于组 1（27 次与 18 次，P=0.05）。在回盲部评估中，组 2 的 EtCO2 值更高（28.94±4.68 mmHg 与 26.65±6.12 mmHg，P=0.04）。在分钟潮气量方面，组 2 在回盲部的数值明显低于组 1（2027.53±2818.89 L/min 与 970.88±1840.25 L/min，P=0.009）。研究期间未发生高碳酸血症（EtCO2＞60 mmHg）。两组镇静药物的使用量无差异。结肠镜检查后，组 2 的疼痛程度明显低于组 1（P=0.05）。
在本研究中，结肠镜检查时使用容量法 EtCO2 监测是可行且有效的，可用于监测通气参数和检测呼吸并发症。CO2 充气是安全的，并且与结肠镜检查后即刻的疼痛程度降低有关。
