The utility of high-flow oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial.

Abstract

STUDY OBJECTIVE:

We determine whether high-flow oxygen reduces the incidence of hypoxia by 20% in adults receiving propofol for emergency department (ED) sedation compared with room air.

METHODS:

We randomized adults to receive 100% oxygen or compressed air at 15 L/minute by nonrebreather mask for 5 minutes before and during propofol procedural sedation. We administered 1.0 mg/kg of propofol, followed by 0.5 mg/kg boluses until the patient was adequately sedated. Physicians and patients were blinded to the gas used. Hypoxia was defined a priori as an oxygen saturation less than 93%; respiratory depression was defined as an end tidal CO(2) greater than 50 mm Hg, a 10% absolute change from baseline, or loss of waveform.

RESULTS:

We noted significantly less hypoxia in the 59 patients receiving high-flow oxygen compared with the 58 receiving compressed air (19% versus 41%; P=.007; difference 23%; 95% confidence interval 6% to 38%). Respiratory depression was similar between groups (51% versus 48%; difference 2%; 95% confidence interval -15% to 22%). We observed 2 adverse events in the high-flow group (1 hypotension, 1 bradycardia) and 2 in the compressed air group (1 assisted ventilation, 1 hypotension).

CONCLUSION:

High-flow oxygen reduces the frequency of hypoxia during ED propofol sedation in adults.

• Authors: Kenneth Deitch, Carl R Chudnofsky, Paul Dominici, Daniel Latta, Yidy Salamanca
• Journal: Annals of emergency medicine (Ann Emerg Med) Vol. 58 Issue 4 Pg. 360-364.e3 (Oct 2011) ISSN: 1097-6760 [Electronic] United States
• PMID: 21680059 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Chemical References

• Hypnotics and Sedatives
• Propofol

Topics

• Adult
• Double-Blind Method
• Emergency Service, Hospital
• Female
• Humans
• Hypnotics and Sedatives (administration & dosage, adverse effects, therapeutic use)
• Hypoxia (chemically induced, prevention & control)
• Male
• Middle Aged
• Oxygen Inhalation Therapy (methods)
• Propofol (administration & dosage, adverse effects, therapeutic use)
• Respiratory Insufficiency (chemically induced, prevention & control)
• Young Adult