STUDY OBJECTIVE: To determine whether supplemental oxygen reduces the incidence of hypoxia by 20% in study patients receiving midazolam and fentanylfor emergency department procedural sedation and analgesia. METHODS: Patients were randomized to receive either supplemental oxygen or compressed air by nasal cannula at 2 L per minute. Physicians were blinded to the gas used and end-tidal carbon dioxide (ETCO2) data. Respiratory depression was defined a priori as oxygen saturation less than 90%, ETCO2 level greater than 50 mm Hg, an absolute change from baseline of 10 mm Hg, or loss of the ETCO2 waveform. RESULTS: Of the 80 patients analyzed, 44 receivedsupplemental oxygen and 36 received compressed air. Twenty supplemental oxygen patients and 19 compressed air patients met at least 1 criterion for respiratory depression. Six supplemental oxygen patients and 5 compressed air patients experienced hypoxia (P=.97; effect size 0%; 95% confidence interval -15% to +15%). Fourteen patients in each group met ETCO2 criteria for respiratory depression but were not hypoxic. Physicians identified respiratory depression in 8 of 11 patients who became hypoxic and 0 of 28 patients who met ETCO2 criteria for respiratory depression but who did not become hypoxic. There were no adverse events. CONCLUSION:Supplemental oxygen did not reduce (or trend toward reducing) the incidence of hypoxia in patients moderately sedated withmidazolam and fentanyl. However, our lower-than-expected rate of hypoxia limits the power of this comparison. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
RCT Entities:
STUDY OBJECTIVE: To determine whether supplemental oxygen reduces the incidence of hypoxia by 20% in study patients receiving midazolam and fentanyl for emergency department procedural sedation and analgesia. METHODS:Patients were randomized to receive either supplemental oxygen or compressed air by nasal cannula at 2 L per minute. Physicians were blinded to the gas used and end-tidal carbon dioxide (ETCO2) data. Respiratory depression was defined a priori as oxygen saturation less than 90%, ETCO2 level greater than 50 mm Hg, an absolute change from baseline of 10 mm Hg, or loss of the ETCO2 waveform. RESULTS: Of the 80 patients analyzed, 44 received supplemental oxygen and 36 received compressed air. Twenty supplemental oxygenpatients and 19 compressed air patients met at least 1 criterion for respiratory depression. Six supplemental oxygenpatients and 5 compressed air patients experienced hypoxia (P=.97; effect size 0%; 95% confidence interval -15% to +15%). Fourteen patients in each group met ETCO2 criteria for respiratory depression but were not hypoxic. Physicians identified respiratory depression in 8 of 11 patients who became hypoxic and 0 of 28 patients who met ETCO2 criteria for respiratory depression but who did not become hypoxic. There were no adverse events. CONCLUSION: Supplemental oxygen did not reduce (or trend toward reducing) the incidence of hypoxia in patients moderately sedated with midazolam and fentanyl. However, our lower-than-expected rate of hypoxia limits the power of this comparison. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
Authors: Melissa L Langhan; Veronika Shabanova; Fang-Yong Li; Steven L Bernstein; Eugene D Shapiro Journal: Am J Emerg Med Date: 2014-10-05 Impact factor: 2.469
Authors: Samuel G Campbell; Kirk D Magee; Peter J Zed; Patrick Froese; Glenn Etsell; Alan LaPierre; Donna Warren; Robert R MacKinley; Michael B Butler; George Kovacs; David A Petrie Journal: World J Emerg Med Date: 2016