Clinical value of the Integrated Pulmonary Index® during sedation for interventional upper GI-endoscopy: A randomized, prospective tri-center study.
BACKGROUND AND STUDY AIMS
The Integrated Pulmonary Index® (IPI) is a mathematically-determined factor based on parameters of capnography and pulse oximetry, which should enable sensitive detection of impaired respiratory function. Aim was to investigate whether an additional measurement of the IPI during sedation for interventional endoscopy, compared to standard monitoring alone, allows a reduction of sedation-related respiratory depression.


PATIENTS AND METHODS
170 patients with standard monitoring randomly underwent either a blinded recording of capnography (control group, n=87) or capnography, including automated IPI calculation (IPI group, n=83), during deep sedation with midazolam and propofol. The primary endpoint was the maximum decrease of oxygen saturation from the baseline level before sedation. Secondary endpoints: incidence of hypoxemia (SaO2<90%), other sedation-related complications (apnea rate, bradycardia, hypotension), patient cooperation and satisfaction (VAS).


RESULTS
Mean propofol dose in the IPI group (245±61mg) was comparable to the control group (225±47mg). The average drop of the oxygen saturation in the IPI group (6.5±4.1%) was nearly identical to that of the control group (7.1±4.6%, p=0.44). Apnea episodes >15s was found in 46 patients of the control and 31 of the IPI group (p<0.05). Frequency of occurrence of a drop in pO2-saturation <90%, bradycardia <50/min or a drop of systolic pressure <90mmHg were not significantly different in both groups. Mechanical ventilation was not required in any case. Patient cooperation and satisfaction were assessed similar in both groups.


CONCLUSION
A clinically appealing advantage of IPI-assessment during deep sedation with midazolam and propofol for interventional endoscopy could not be documented. However, IPI registration was more effective in reducing the incidence of apnea episodes.
['Riphaus|Andrea|A|', 'Wehrmann|Till|T|', 'Kronshage|Tim|T|', 'Geist|Christoph|C|', 'Pox|Christian P|CP|', 'Heringlake|Stefan|S|', 'Schmiegel|Wolff|W|', 'Beitz|Analena|A|', 'Meining|Alexander|A|', 'Müller|Michaela|M|', 'von Delius|Stefan|S|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001049:Apnea D019296:Capnography D054810:Deep Sedation D016099:Endoscopy, Gastrointestinal D005260:Female D005858:Germany D006801:Humans D006993:Hypnotics and Sedatives D000860:Hypoxia D008297:Male D008874:Midazolam D008875:Middle Aged D010092:Oximetry D010100:Oxygen D015742:Propofol D011446:Prospective Studies
Midazolam Propofol Hypoxemia Apnea Endoscopic resection Endoscopic sedation Endoscopic ultrasound Gastrointestinal endoscopy