Document Detail


The utility of supplemental oxygen during emergency department procedural sedation with propofol: a randomized, controlled trial.
MedLine Citation:
PMID:  18294729     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: We determine whether supplemental oxygen reduces the incidence of hypoxia by 20% compared with breathing room air in adult study patients receiving propofol for emergency department procedural sedation. METHODS: Patients were randomized to receive either supplemental oxygen or compressed air by nasal cannula at 3 L per minute. Physicians were blinded to the gas used and end tidal CO(2) (etco(2)) data. Respiratory depression was defined a priori as oxygen saturation less than or equal to 93%, an etco(2) level of greater than or equal to 50 mm Hg, an absolute etco(2) change from baseline of greater than or equal to 10 mm Hg, or loss of the etco(2) waveform. RESULTS: Of the 110 patients analyzed, 56 received supplemental oxygen and 54 received room air. Ten (18%) patients in the supplemental oxygen group and 15 (28%) patients in the compressed air group experienced hypoxia (P=.3, effect size=10%, 95% confidence interval -24% to 7%). Twenty-seven patients (20 supplemental oxygen; 7 room air) met etco(2) criteria for respiratory depression but did not become hypoxic. Physicians identified respiratory depression in 23 of 25 patients who developed hypoxia compared with only 1 of 27 patients who met etco(2) criteria for respiratory depression but who did not have hypoxia. One patient in the supplemental oxygen group experienced a transient arrhythmia and had a short apneic episode, both of which resolved spontaneously. The patient was admitted for observation. CONCLUSION: Supplemental oxygen (3 L/minute) trended toward reducing hypoxia in adult study patients; however, the 10% difference observed was not statistically significant and was below our a priori 20% threshold. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
Authors:
Kenneth Deitch; Carl R Chudnofsky; Paul Dominici
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2008-03-04
Journal Detail:
Title:  Annals of emergency medicine     Volume:  52     ISSN:  1097-6760     ISO Abbreviation:  Ann Emerg Med     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-20     Completed Date:  2008-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA 19141, USA. Deitchk@Einstein.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anoxia / diagnosis,  prevention & control*
Capnography
Chi-Square Distribution
Child
Child, Preschool
Conscious Sedation*
Double-Blind Method
Emergency Service, Hospital
Female
Humans
Hypnotics and Sedatives / administration & dosage*
Male
Middle Aged
Oxygen / blood
Oxygen Inhalation Therapy*
Propofol / administration & dosage*
Prospective Studies
Respiratory Insufficiency / diagnosis
Treatment Outcome
Chemical
Reg. No./Substance:
0/Hypnotics and Sedatives; 2078-54-8/Propofol; 7782-44-7/Oxygen
Comments/Corrections
Comment In:
Ann Emerg Med. 2008 Jul;52(1):9-10   [PMID:  18282637 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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