Efficacy of End-Tidal Capnography Monitoring during Flexible Bronchoscopy in Nonintubated Patients under Sedation: A Randomized Controlled Study

Ishiwata, Tsukasa; Tsushima, Kenji; Terada, Jiro; Fujie, Mai; Abe, Mitsuhiro; Ikari, Jun; Kawata, Naoko; Tada, Yuji

doi:10.1159/000489888

Cited by 15 publications

(15 citation statements)

References 26 publications

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“…It has been published that the nadir on SpO 2 decline could be delayed by 45-60 seconds after an apnea episode (18). The capnographic monitoring allows for the earlier detection of apnea episodes in patients undergoing bronchoscopic examinations under midazolam sedation, more real measurement values of carbon dioxide than pulse oximetry (15,16). In our study, cap-ONE YG-227T (NIHON KOHDEN) detected the occurrence of apnea in patients undergoing a bronchoscopic examination under fentanyl and midazolam sedation.…”

Section: Discussionmentioning

confidence: 53%

“…Moderate sedation is necessary for safe bronchoscopy examination to prevent apnea and oxygen desaturation. End-tidal capnography monitored the occurrence of apnea episodes at a high frequency in patients during a bronchoscopic examination under midazolam sedation in a clinical setting (15,16). Here, we retrospectively revealed the occurrence of apnea episodes during bronchoscopic examinations under fentanyl and midazolam sedation by end-tidal capnography.…”

Section: Introductionmentioning

confidence: 99%

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End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation

Minami¹,

Murakami²,

Shibata³

et al. 2021

Ann Palliat Med

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Background: Bronchoscopic examination including endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is well established for lung cancer diagnosis and staging. Sedation using fentanyl and midazolam is recommended during bronchoscopic examinations. Meanwhile, inadvertent oversedation is a clinical problem. The objective of this research was to estimate the frequency of apnea episodes by endtidal capnography under fentanyl and midazolam sedation during bronchoscopy.Methods: Eighty-five patients were enrolled retrospectively between August 2017 and March 2018 at Okayama Medical Center. Apnea was defined as the cessation of airflow for more than 10 seconds. We reviewed medical records, including capnographic data, by cap-ONE YG-227T (NIHON KOHDEN, Tokyo, Japan) during flexible bronchoscopy under fentanyl and midazolam sedation.Results: Patients received 49.4±20.6 µg of fentanyl [mean ± standard deviation (SD)] and 4.35±2.0 mg of midazolam (mean ± SD). The patients included 52 males and 33 females; the median age was 71 (range, 31-88) years were enrolled. Apnea episodes were recorded (median duration 18 seconds) in 85 patients (100%). Prolonged apnea episodes with more than 30 seconds occurred in 56 patients (65.8%). Furthermore, the median time was 32 (range, 5-102) seconds whose delay between the onset of an apnea episode and decline in the SpO 2 level of ≥4% from baseline.Conclusions: End-tidal capnography, cap-ONE YG-227T was effective for detecting the occurrence of apnea in patients undergoing a bronchoscopic examination under fentanyl and midazolam sedation.Monitoring might be useful for preventing inadvertent oversedation.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation

Minami¹,

Murakami²,

Shibata³

et al. 2021

Ann Palliat Med

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“…A study showed the superiority of tPCO2 to end tidal CO2 and suggested that upper airway muscle weakness due to propofol is the reason that end tidal CO2 monitoring is not useful [9]. Another study reported that false apnea alarms occurred 83 times in 185 patients monitored by end-tidal CO2 capnography [7]. The current study aimed to reach the optimum sedation level necessary for the bronchoscopist to complete the procedure successfully.…”

Section: Discussionmentioning

confidence: 89%

“…Previous studies have reported a correlation between end tidal CO2 and tPCO2 in volunteers and in spontaneously breathing patients in the intensive care unit [7,8]. A study showed the superiority of tPCO2 to end tidal CO2 and suggested that upper airway muscle weakness due to propofol is the reason that end tidal CO2 monitoring is not useful [9].…”

Section: Discussionmentioning

confidence: 99%

Transcutaneous carbon dioxide monitoring during flexible bronchoscopy under sedation: A prospective observational study

Yaman¹,

Günal²

2020

Journal of Surgery and Medicine

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Ethical Committee of Clinical Studies (decision number: 21.03). All procedures in this study involving human participants were performed in accordance with the 1964 Helsinki Declaration and its later amendments. Etik Kurul Onayı: Bu çalışma için onay Kırıkkale Üniversitesi Klinik Araştırmalar Etik Kurulu'ndan alınmıştır (karar no: 21.03). İnsan katılımcıların katıldığı çalışmalardaki tüm prosedürler, 1964 Helsinki Deklarasyonu ve daha sonra yapılan değişiklikler uyarınca gerçekleştirilmiştir.

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“…Our findings are consistent with this, although derived on a purely empirical basis. It might be of interest that there are multiple other uses of capnography beyond diagnostic applications, particularly in anesthesiology and bronchoscopic interventions [28], in which the end-tidal CO 2 concentration plays a major role. We did not evaluate this parameter, but it might well be related to AreaVol s3, which we used for diagnostic purposes.…”

Section: Ratio Area/volume Of Phasementioning

confidence: 99%

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

et al. 2020

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Background: Capnovolumetry is of interest as a method for the diagnosis of obstructive airway diseases, requiring little cooperation from the patient. Objective: To help in the interpretation of capnovolumetric parameters, we aimed to identify their correspondence to conventional lung function indices. Methods: We studied 978 patients from a diagnostic study with complete functional data and the clinical diagnosis of asthma, chronic obstructive pulmonary disease (COPD), or no respiratory disease. Using path analysis, four capnovolumetric parameters (slope of expiratory phase 3, ratio of slopes of phases 3 and 2, volume of phase 2, and the ratio area/volume of phase 3) previously identified as predictors of airway obstruction in terms of spirometry and body plethysmography, were analyzed regarding their relationship to each other and the diagnostic categories of asthma or COPD versus control, or obstruction versus no obstruction. We then identified four lung function parameters showing relationships as much as possible isomorphic to those between capnovolumetric parameters. Results: The four capnovolumetric parameters were related to COPD and obstruction via both direct and indirect influences, but only two of them to asthma. Regarding the correspondence to lung function parameters, the slope of expiratory phase 3 corresponded best to the ratio of residual volume to total lung capacity, the ratio of slopes of phases 3 and 2 to forced expiratory volume in 1 s, the volume of phase 2 to forced expired flow at 50% of vital capacity, and the ratio area/volume of phase 3 to forced vital capacity. Conclusions: Our results indicated an intricate relationship of capnovolumetric parameters to each other and to airway obstruction, asthma, or COPD. The correspondence to conventional lung function measures seemed to reflect the entities lung hyperinflation, overall ventilatory impairment, bronchoconstriction, and ventilated lung volume, in that order. These findings might be helpful for clinicians in the interpretation of capnovolumetry.

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Efficacy of End-Tidal Capnography Monitoring during Flexible Bronchoscopy in Nonintubated Patients under Sedation: A Randomized Controlled Study

Cited by 15 publications

References 26 publications

End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation

End-tidal capnographic monitoring during flexible bronchoscopy under fentanyl and midazolam sedation

Transcutaneous carbon dioxide monitoring during flexible bronchoscopy under sedation: A prospective observational study

Correspondence between Capnovolumetric and Conventional Lung Function Parameters in the Diagnosis of Obstructive Airway Diseases

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