Drews Jan, Harder Jonas, Kaiser Hannah, Soenarjo Miriam, Spahlinger Dorothee, Wohlmuth Peter, Wirtz Sebastian, Eberhardt Ralf, Bornitz Florian, Bunde Torsten, von Hahn Thomas
Department of Gastroenterology, Hepatology and Interventional Endoscopy, Asklepios Hospital Barmbek, Hamburg, Germany.
Semmelweis University of Medicine, Asklepios Campus Hamburg, Hamburg, Germany.
Clin Endosc. 2024 Mar;57(2):196-202. doi: 10.5946/ce.2023.010. Epub 2023 Jun 27.
BACKGROUND/AIMS: Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies.
We compared overweight patients (body mass index >25 kg/m2) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes.
We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO2] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO2 <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO2 and the lowest SpO2 recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008).
Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.
背景/目的：低氧血症是内镜检查期间丙泊酚镇静的常见副作用。使用鼻罩施加轻度气道正压（PAP）可能提供一种简单的方法来减少此类事件，并优化上消化道诊断性和治疗性内镜检查的条件。
我们比较了体重超重（体重指数>25kg/m²）的患者，这些患者在接受由非麻醉医生给予丙泊酚镇静的上消化道内镜检查时，分别使用鼻PAP面罩或标准鼻导管。结果参数包括低氧血症发作的频率和严重程度。
我们分析了51例使用鼻PAP面罩的患者和51例对照组患者的102例手术。对照组中有25例（49.0%）出现低氧血症发作（镇静期间任何时间的血氧饱和度[SpO₂]<90%），而使用鼻PAP面罩的患者中有8例（15.7%）出现低氧血症发作（p<0.001）。两组均有3例个体（5.9%）出现严重低氧血症（SpO₂<80%）。与对照组相比，使用鼻PAP面罩患者的基线SpO₂与记录的最低SpO₂之间的平均差值显著降低（分别相差3.7和8.2个百分点）。鼻PAP面罩组进行气道干预的次数明显较少（15.7%对41.2%，p=0.008）。
使用鼻PAP面罩可能是提高患者安全性和检查便利性的一种简单方法。
