Hypercapnia in COPD Patients Undergoing Endobronchial Ultrasound under Local Anaesthesia and Analgosedation: A Prospective Controlled Study Using Continuous Transcutaneous Capnometry
| Autor: | Friederike Sophie Magnet, Thomas Galetin, Erich Stoelben, Daniel Strohleit, Jost Schnell, Aris Koryllos |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Sedation Hypercapnia Pulmonary Disease Chronic Obstructive 03 medical and health sciences 0302 clinical medicine Bronchoscopy medicine Humans Prospective Studies 030212 general & internal medicine Normocapnia Alfentanil Endoscopic Ultrasound-Guided Fine Needle Aspiration COPD medicine.diagnostic_test business.industry medicine.disease 030228 respiratory system Anesthesia Breathing Midazolam medicine.symptom business Blood Gas Monitoring Transcutaneous Anesthesia Local medicine.drug |
| Zdroj: | Respiration. 100:958-968 |
| ISSN: | 1423-0356 0025-7931 |
| DOI: | 10.1159/000515920 |
| Popis: | Background: Flexible bronchoscopy (FB) in analgosedation causes alveolar hypoventilation and hypercapnia, the more so if patients suffer from COPD. Nonetheless, neither is capnometry part of standard monitoring nor is there evidence on how long patients should be monitored after sedation. Objectives: We investigated the impact of COPD on hypercapnia during FB with endobronchial ultrasound (EBUS) in sedation and how the periprocedural monitoring should be adapted. Methods: Two cohorts of consecutive patients – with advanced and without COPD – with the indication for FB with EBUS-guided transbronchial needle aspiration in analgosedation received continuous transcutaneous capnometry (ptcCO2) before, during, and for 60 min after the sedation with midazolam and alfentanil. Main Results: Forty-six patients with advanced COPD and 44 without COPD were included. The mean examination time was 26 ± 9 min. Patients with advanced COPD had a higher peak ptcCO2 (53.7 ± 7.1 vs. 46.8 ± 4.8 mm Hg, p < 0.001) and mean ptcCO2 (49.5 ± 6.8 vs. 44.0 ± 4.4 mm Hg, p < 0.001). Thirty-six percent of all patients reached the maximum hypercapnia after FB in the recovery room (8 ± 11 min). Patients with COPD needed more time to recover to normocapnia (22 ± 24 vs. 7 ± 11 min, p < 0.001). They needed a nasopharyngeal tube more often (28 vs. 11%, p < 0.001). All patients recovered from hypercapnia within 60 min after FB. No intermittent ventilation manoeuvres were needed. Conclusion: A relevant proportion of patients reached their peak-pCO2 after the end of intervention. We recommend using capnometry at least for patients with known COPD. Flexible EBUS in analgosedation can be safely performed in patients with advanced COPD. For patients with advanced COPD, a postprocedural observation time of 60 min was sufficient. |
| Databáze: | OpenAIRE |
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