A prospective observation study of the dynamic monitoring of transcutaneous arterial blood oxygen saturation and carbon dioxide during bronchoscopy.

IF 5.8 2区 医学 Q1 Medicine
Yusuke Shinozaki, Kei Morikawa, Kida Hirotaka, Kazuhiro Nishiyama, Satoshi Tanaka, Hajime Tsuruoka, Shin Matsuzawa, Hiroshi Handa, Hiroki Nishine, Masamichi Mineshita
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引用次数: 0

Abstract

Background and aims: Because bronchoscopy is an invasive procedure, sedatives and analgesics are commonly administered, which may suppress the patient's spontaneous breathing and can lead to hypoventilation and hypoxemia. Few reports exist on the dynamic monitoring of oxygenation and ventilation during bronchoscopy. This study aimed to prospectively monitor and evaluate oxygenation and ventilation during bronchoscopy using transcutaneous arterial blood oxygen saturation and carbon dioxide.

Methods: We included patients who required pathological diagnosis using fluoroscopic bronchoscopy at our hospital between March 2021 and April 2022. Midazolam was intravenously administered to all patients as a sedative during bronchoscopy, and fentanyl was administered in addition to midazolam when necessary. A transcutaneous blood gas monitor was used to measure dynamic changes, including arterial blood partial pressure of carbon dioxide (tcPCO2), transcutaneous arterial blood oxygen saturation (SpO2), pulse rate, and perfusion index during bronchoscopy. Quantitative data of tcPCO2 and SpO2 were presented as mean ± standard deviation (SD) (min-max), while the quantitative data of midazolam plus fentanyl and midazolam alone were compared. Similarly, data on sex, smoking history, and body mass index were compared. Subgroup comparisons of the difference (Δ value) between baseline tcPCO2 at the beginning of bronchoscopy and the maximum value of tcPCO2 during the examination were performed.

Results: Of the 117 included cases, consecutive measurements were performed in 113 cases, with a success rate of 96.6%. Transbronchial lung biopsy was performed in 100 cases, whereas transbronchial lung cryobiopsy was performed in 17 cases. Midazolam and fentanyl were used as anesthetics during bronchoscopy in 46 cases, whereas midazolam alone was used in 67 cases. The median Δ value in the midazolam plus fentanyl and midazolam alone groups was 8.10 and 4.00 mmHg, respectively, indicating a significant difference of p < 0.005. The mean ± standard deviation of tcPCO2 in the midazolam plus fentanyl and midazolam alone groups was 44.8 ± 7.83 and 40.6 ± 4.10 mmHg, respectively. The SpO2 in the midazolam plus fentanyl and midazolam alone groups was 94.4 ± 3.37 and 96.2 ± 2.61%, respectively, with a larger SD and greater variability in the midazolam plus fentanyl group.

Conclusion: A transcutaneous blood gas monitor is non-invasive and can easily measure the dynamic transition of CO2. Furthermore, tcPCO2 can be used to evaluate the ventilatory status during bronchoscopy easily. A transcutaneous blood gas monitor may be useful to observe regarding respiratory depression during bronchoscopy, particularly when analgesics are used.

支气管镜检查期间经皮动脉血氧饱和度和二氧化碳动态监测的前瞻性观察研究。
背景和目的:由于支气管镜检查是一种侵入性手术,通常会使用镇静剂和镇痛剂,这可能会抑制患者的自主呼吸,导致通气不足和低氧血症。关于支气管镜检查过程中氧合和通气的动态监测报告很少。本研究旨在使用经皮动脉血氧饱和度和二氧化碳对支气管镜检查期间的氧合和通气进行前瞻性监测和评估:我们纳入了 2021 年 3 月至 2022 年 4 月期间在我院使用透视支气管镜进行病理诊断的患者。所有患者在支气管镜检查过程中均静脉注射咪达唑仑作为镇静剂,必要时除咪达唑仑外还会注射芬太尼。支气管镜检查期间,使用经皮血气监测仪测量动态变化,包括动脉血二氧化碳分压(tcPCO2)、经皮动脉血氧饱和度(SpO2)、脉搏和灌注指数。tcPCO2和SpO2的定量数据以平均值±标准差(SD)(最小值-最大值)表示,同时比较了咪达唑仑加芬太尼和咪达唑仑单独使用的定量数据。同样,还比较了性别、吸烟史和体重指数等数据。对支气管镜检查开始时的基线 tcPCO2 与检查期间 tcPCO2 最大值之间的差异(Δ 值)进行了分组比较:结果:在纳入的 117 个病例中,有 113 个病例进行了连续测量,成功率为 96.6%。100例进行了经支气管肺活检,17例进行了经支气管肺冷冻活检。支气管镜检查中使用咪达唑仑和芬太尼作为麻醉剂的有46例,而仅使用咪达唑仑的有67例。咪达唑仑加芬太尼组和单纯咪达唑仑组的中位Δ值分别为 8.10 和 4.00 mmHg,表明咪达唑仑加芬太尼组和单纯咪达唑仑组的 p 2 分别为 44.8 ± 7.83 和 40.6 ± 4.10 mmHg,差异显著。咪达唑仑加芬太尼组和咪达唑仑单药组的 SpO2 分别为 94.4 ± 3.37% 和 96.2 ± 2.61%,咪达唑仑加芬太尼组的 SD 更大,变异性更大:结论:经皮血气监测仪是无创的,可以轻松测量二氧化碳的动态变化。此外,tcPCO2 可用于评估支气管镜检查期间的通气状况。经皮血气监测仪可用于观察支气管镜检查期间的呼吸抑制情况,尤其是在使用镇痛剂时。
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来源期刊
Respiratory Research
Respiratory Research RESPIRATORY SYSTEM-
CiteScore
9.70
自引率
1.70%
发文量
314
审稿时长
4-8 weeks
期刊介绍: Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.
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