Value of integrated pulmonary index monitoring for the detection of adverse respiratory events in patients undergoing sedation for gastrointestinal system endoscopy

Abstract

Objective: To determine if the integrated pulmonary index detects changes in ventilation status early in patients undergoing gastrointestinal endoscopy under sedation, and to determine the risk factors affecting hypoxia. Method: The retrospective study was conducted at the endoscopy unit of a tertiary university hospital in Turkey and comprised data between October 2018 and December 2019 related to patients of either gender aged >18 years who were assessed as American Society of Anaesthesiologists grade I -III and underwent elective lower and upper gastrointestinal endoscopy. Monitoring was done with capnography in addition to standard procedures. Data was analysed using SPSS 23. Results: Of the 154 patients, 94(%) were females and 60(%) were males. The overall mean age was 50.88 +/- 11.8 years (range: 20-70 years). Mean time under anaesthesia was 23.58 +/- 4.91 minutes and mean endoscopy time was 21.73 +/- 5.06 minutes. During the procedure, hypoxia was observed in 42(27.3%) patients, severe hypoxia in 23(14.9%) and apnoea in 70(45.5%). Mean time between apnoea and hypoxia was 12.59 +/- 7.99 seconds, between apnoea and serious hypoxia 21.07 +/- 17.64 seconds, between integrated pulmonary index score 1 and hypoxia 12.91 +/- 8.17 sec, between integrated pulmonary index score 1 and serious hypoxia 21.59 +/- 14.13 seconds, between integrated pulmonary index score <7 and hypoxia 19.63 +/- 8.89 seconds, between integrated pulmonary index score <7 and serious hypoxia 28.39 +/- 12.66 seconds, between end -tidal carbon dioxide and hypoxia 12.95 +/- 8.33 seconds, and between end -tidal carbon dioxide and serious hypoxia 21.29 +/- 7.55 seconds. With integrated pulmonary index score 1, sensitivity value for predicting hypoxia and severe hypoxia was 88.1% and 95.7%, respectively, and specificity was 67% and 60.3%, respectively. With integrated pulmonary index score <7, the corresponding values were 100%, 100%, 42% and 64.1%, respectively. Conclusion: Capnographic monitoring, especially the follow-up integrated pulmonary index score, was found to be valuable and reliable in terms of finding both time and accuracy of the risk factor in the diagnosis of respiratory events.