Clinical Trial: Capnography Monitoring in the Bronchoscopic Sedation

Study Status: Completed
Recruit Status: Completed
Study Type: Interventional

Official Title: Capnography Monitoring the Hypoventilation During Bronchoscopic Sedation

Brief Summary: Procedure sedation of flexible bronchoscopy (FB) comforts patients undergoing FB. Hypoventilation during FB is a concern. The investigators investigate the feasibility of monitoring capnography in FB sedation.

Detailed Summary:

Patients undergoing flexible bronchoscopy (FB) experience procedure-related symptoms. Current guidelines of FB recommend sedation to all patients undergoing FB, except when there are contraindications. Propofol or benzodiazepines plus an opioid are the common combination used to improve patient tolerance and satisfaction during FB. However, controversy about combining propofol and opioids persists because of the risk of over-sedation and cardiopulmonary depression.

While transition from alert into sedation during induction, like sleep, the respiratory drive and muscle tone of respiratory muscle and upper airway attenuate, which contribute hypoventilation and upper airway collapse, and further hypoxemia. Detection of cardiopulmonary depression traditionally has relied on continuous monitoring of heart rate, respiratory rate, and oxygen saturation. However, it has been shown that these monitors could not recognize hypoventilation early. Similar with other published data, around 40% of hypoxemia event occurred during FB sedation in our hospital. Further analysis of our data revealed around 15% event occurred during sedative induction.

Capnography is the noninvasive measurement of the partial pressure of carbon dioxide (CO2) from the airway during ventilation. The maximum partial pressure of CO2 obtained at the end of an exhaled breath is referred to as end-tidal CO2 (EtCO2). Studies have revealed the waveform analysis of capnography can provide early warning for prehypoxic respiratory depression in patients undergoing procedure sedation in emergency department and gastrointestinal endoscopy. Therefore, capnography can serve as a real-time measure of ventilatory status of sedative patients and the physicians could intervene before the occurrence of hypoxemia. Based on the advantage of non-invasive and real-time property of EtC
Sponsor: Chang Gung Memorial Hospital

Current Primary Outcome: Hypoxemia [ Time Frame: 60 minutes ]

Oxyhemoglobin saturation less than 90% with any duration after induction to patient recovery.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Patient satisfaction [ Time Frame: 60 minutes ]
    A 10cm visual analogue scale about how the patients fell about the bronchoscopy
  • Patient cooperation accessed by bronchoscopists [ Time Frame: 60 minutes ]
    A 10cm visual analogue scale about how the bronchoscopists fell the cooperation of patients during bronchoscopy.
  • Induction time [ Time Frame: 10 minutes ]
    The length of time for achieving adequate sedative depth to start bronchoscopy
  • Procedure time [ Time Frame: 30 minutes ]
    The length of time for complete bronchoscopy
  • Propofol dosage [ Time Frame: 60 minutes ]
    the dose of propofol for induction and whole bronchoscopy


Original Secondary Outcome: Same as current

Information By: Chang Gung Memorial Hospital

Dates:
Date Received: March 18, 2015
Date Started: January 2015
Date Completion:
Last Updated: March 8, 2017
Last Verified: March 2017