Procedures: Procedures 2 |

Patient and Procedure Characteristics Associated With High Sedation Requirements During Bronchoscopy Including EBUS Guided Sampling FREE TO VIEW

Pooja Belligund, MD; Francis Christian, MD; Mohammad Al-Ajam, MD; Vanthanh Ly, MD; Gangacharan Dubey, MD; Abhijit Mahalingashetty, MD; Natalie Ho, PharmD; Naveen Singh, MD; Michael Cutaia, MD
Author and Funding Information

VA Medical Center, Brooklyn, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1014A. doi:10.1016/j.chest.2016.08.1120
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SESSION TITLE: Procedures 2

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Studies comparing deep sedation or general anesthesia with moderate sedation for bronchoscopy, including EBUS, show an increase in hypotension, desaturation, and difficulty completing the procedure (9), as well as a decrease in diagnostic yield (8). A large study looking at factors affecting sedation in upper endoscopy and colonoscopy found correlations for age, BMI, benzodiazepine and opioid use among others (2). A recent VA ICU study demonstrated an association between PTSD and higher propofol requirements for sedation while on mechanical ventilation and association with worse outcomes (7). However, few studies (5, 6) have looked at a comprehensive list of factors that may affect sedation during bronchoscopic procedures.

METHODS: We conducted a retrospective review of bronchoscopy procedures done under moderate sedation (2009-2015) at our institution. We performed a multiple regression analysis to determine the association of the following factors: type of procedure (EBUS vs non-EBUS), procedure length, age, BMI, history of alcohol abuse, history of substance abuse, history of opioid and benzodiazepine use, psychiatric history including PTSD, use of psychoactive or antidepressant medications, use of sleep aids (for eg.zolpidem) and medical comorbidities (Charlson’s comorbidity index) with the primary outcome of “difficult to sedate” patients. This was defined as the composite of all patients that received the highest dose (highest quartile)of benzodiazepines and opioids or those that had documented difficulty with sedation or abortion of procedure. To correct for variability with procedure time, we repeated the analysis against the composite outcome of high sedation ratio (sedation dose/procedure time) or documented difficulty with sedation.

RESULTS: 389 unique patients were included. 195 had a Bronchoscopy that involved EBUS guided sampling. Mean age was 67 years. Higher BMI (p=.01), younger age (p=.0007), and shorter procedure time (p<.0001) were associated with difficult to sedate patients. There was a trend towards difficulty with sedation in patients with sleep aid use (p=0.07) and alcohol abuse (p=0.09).

CONCLUSIONS: Factors associated with difficult sedation include younger age and higher BMI. Clinical comorbidities, PTSD, prior benzodiazepine or opiate use were not significant. When corrected for total duration of procedure, patients in the difficult to sedate group had a shorter procedure duration (68 vs 37 minutes).

CLINICAL IMPLICATIONS: These findings have significant workflow implications. This is the first study to look at an extensive list of risk factors associated with difficult to sedate patients. Further delineating this group of patients may be important for appropriate patient selection for safe and effective procedures under moderate sedation. The trend towards significance with a history of alcohol abuse or use of sleep aids suggests the need for a larger study to assess their correlation to the primary outcome.

DISCLOSURE: The following authors have nothing to disclose: Pooja Belligund, Francis Christian, Mohammad Al-Ajam, Vanthanh Ly, Gangacharan Dubey, Abhijit Mahalingashetty, Natalie Ho, Naveen Singh, Michael Cutaia

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