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Education, Teaching, and Quality Improvement |

The Use of a Noninvasive Respiratory Volume Monitor to Measure the Adequacy of Ventilation in Patients Under Conscious Sedation for Routine Endoscopic Procedures

Katherine Holley, DO; Donald Mathews, MD; Lisa Campana, PhD; Diane Ladd, DNSc; Jonathan Lee, BS; Howard Schapiro, MD
Author and Funding Information

Fletcher Allen Health Care, University of Vermont College of Medicine, Burlington, VT


Chest. 2013;144(4_MeetingAbstracts):573A. doi:10.1378/chest.1698786
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Abstract

SESSION TITLE: Patient Safety Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Upper endoscopic procedures are generally performed under conscious sedation which requires careful monitoring of respiratory status to prevent adverse outcomes. Effective monitoring remains difficult with current technology. While both capnography and pulse oximetry are capable of detecting severe adverse events, neither is sensitive enough to detect early signs of hypoventilation. This study evaluates the use of a novel, non-invasive Respiratory Volume Monitor (RVM) to quantify ventilation before, during, and after endoscopic procedures. The RVM has been shown to be capable of detecting changes in ventilation potentially predicting and preventing life-threatening hypoventilation.

METHODS: Thirteen patients (age: 54 ± 5 years, BMI: 29 ± 2 kg/m2) undergoing endoscopic procedures were monitored using an RVM (ExSpiron™, Respiratory Motion, Inc., Waltham, MA). During the study, real-time minute ventilation (MV), tidal volume (TV), and respiratory rate (RR) were recorded. All patients were sedated with propofol and airway maneuvers (chin-lifts and jaw-thrusts) were performed as needed to maintain airway patency during the procedure. These procedures included endoscopic ultrasound (n = 4), esophagogastroduodenoscopy (n = 5), gastroscopy (n = 1), and endoscopic retrograde cholangiopancreatography (n = 3).

RESULTS: Prior to sedation (baseline), the RVM recorded an average MV of 10.3 ± 0.9 L/min, TV of 710 ± 70 mL, and RR of 15.6 ± 1.2 breaths/min. A nadir in ventilation occurred 25 minutes after the last dose of propofol with a significant reduction in MV to 6.8 ± 1.0 L/min, (-30%±9%, p<0.05) and TV to 470 ± 50 mL (-22%±10%, p<0.05) with a small, non-significant reduction in RR to14.3 ± 1.5 breaths/min, (-4.8%±10%, p=0.48) relative to baseline. In 10 of the patients, 20 airway maneuvers were performed to improve ventilation. MV was significantly increased immediately following an airway maneuver (from 5.1 ± 0.7 L/min to 6.7 ± 0.8 L/min, an increase of 31%, p<0.05).

CONCLUSIONS: These results show that the RVM can be a useful tool to assess the adequacy of ventilation in the endoscopic environment.

CLINICAL IMPLICATIONS: Continuous non-invasive monitoring with the RVM can help clinicians quantify the degree of respiratory depression induced by sedatives and narcotics, as well as evaluate the effectiveness of airway management in real time, potentially minimizing adverse outcomes and improving patient safety.

DISCLOSURE: Lisa Campana: Employee: Respiratory Motion, Inc. Diane Ladd: Employee: Respiratory Motion, Inc. Jonathan Lee: Employee: Respiratory Motion. Inc. The following authors have nothing to disclose: Katherine Holley, Donald Mathews, Howard Schapiro

No Product/Research Disclosure Information


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