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Respiratory Care |

Utility of Noninvasive Ventilation (NIV) in High-Risk Patients During Endoscopic Retrograde Cholangiopancreatography (ERCP)

Patricia Lazo Meneses, MD; Salvador Diaz Lobato, PhD; Sagrario Mayoralas Alises, PhD; Jonathan Cámara Fernández, MD; Patricia Castro Acosta, MD; Paola Arrieta Narvaez, MD; Carolina Gotera, MD; Carolina Jurkojc Mohremberger, MD; Eva Mañas Baena, MD
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Hospital Universitario Ramón y Cajal, Madrid, Spain


Chest. 2014;145(3_MeetingAbstracts):554A. doi:10.1378/chest.1824265
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Abstract

SESSION TITLE: Non-Invasive Ventilation

SESSION TYPE: Slide Presentations

PRESENTED ON: Saturday, March 22, 2014 at 12:15 PM - 01:15 PM

PURPOSE: Introduction We know the role of non-invasive ventilation (NIV) in the prevention of respiratory complications in high-risk patients who undergo ERCP.

METHODS: We propose a randomized controlled study in 37 consecutive patients who underwent ERCP and considered high risk, according to present at least one of the following criteria: age> 70 years, BMI> 35, NYHA II-IV CHF, heart disease ischemic or COPD. A total of 21 patients received O2 and 16 received noninvasive ventilation by nasal mask. Arterial blood gases were performed before and immediately after ERCP. APACHE score was obtained from the patients. Propofol was administered until a sedation level 3-4 on the Ramsay scale,

RESULTS: Both groups were homogeneous. The post-ERCP PCO2 was lower (p = 0.001) and post ERCP pH was greater (p = 0.001) in the group of patients with NIV. In multivariate analysis adjusting for gender, APACHE score, pH, PCO2 pre-ERCP, age, propofol dose and duration of the procedure, these differences remained significant. (pCO2 difference = 5.54, 95% CI = 2.3-8.7, pH difference = 0.047, 95% CI = 0013-0081). There were 4 complications, one in the NIV group (hypotension) and 3 in the O2 group (two cardiac arrhythmias and gastrointestinal bleeding).

CONCLUSIONS: In high-risk patients who undergo ERCP, NIV prevents the appearence of hypercapnia and respiratory acidosis.

CLINICAL IMPLICATIONS: Endoscopic retrograde cholangiopancreatography (ERCP) with sedation and analgesia performed by well-trained endoscopists has proved to be a safe procedure, although significant complications may occur as a result of instrumentation or due to the effects of sedation and analgesia. These complications are more frequent when patients are deeply sedated, undergo complex or prolonged explorations, or undergo therapeutic procedures. Respiratory complications are very important in high risk patients. Respiratory insufficiency and clinical hypoventilation are common during the realization of ERCP for patients with hypoventilation risk factors such as the elderly, patients with cardiopathy, patients with a history of respiratory failure, patients who are morbidly obese, and patients with obesity-hypoventilation syndrome. The purpose of our study is to assess whether NIV can prevent ventilatory alterations during ERCP in patients with risk factors associated with the development of hypoventilation.

DISCLOSURE: The following authors have nothing to disclose: Patricia Lazo Meneses, Salvador Diaz Lobato, Sagrario Mayoralas Alises, Jonathan Cámara Fernández, Patricia Castro Acosta, Paola Arrieta Narvaez, Carolina Gotera, Carolina Jurkojc Mohremberger, Eva Mañas Baena

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