Endoskopik retrograd kolanjio pankreatografi (ERKP) uygulanan olguların güvenli sedasyonunda kapnografinin rolü
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Date
2021
Authors
Gökce, Merve
Journal Title
Journal ISSN
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Çalışmamızda; sedasyon altında yapılan endoskopik retrograd kolanjio pankreatografi (ERKP) olgularında, rutin monitörizasyona ek olarak yapılan kapnografi monitörizasyonunun, oksijen desatürasyonuna, hipoksemiye ve diğer vital parametrelere etkisini araştırmayı hedefledik. Çalışmamıza sedasyon uygulanan, 18 yaş ve üstü 80 ERKP olgusu dahil edildi. Olgular, hasta grubu (rutin monitörizasyon ve kapnografi monitorizasyonu) ile kontrol grubu (yalnız rutin monitörizasyon) şeklinde ikiye ayrıldı. İki gruptaki desatürasyon, hipoksemi, taşikardi, bradikardi gelişimi ve havayolu yönetiminde kullanılan müdahaleler; kalitatif ve kantitatif açıdan kıyaslandı. Hasta grubunda end-tidal karbondioksit (EtCO2) yüksekliği ve düşüklüğünün, desatürasyon ve hipoksemi gelişiminin, dikkat edilmesi gereken integrated pulmonary index (IPI) düzeylerinin (5-7) ve müdahale gerektiren IPI düzeylerinin (1-4) görülme sıklığı; birbirleriyle ve diğer parametrelerle ilişkileri değerlendirildi. Hasta grubunda hiçbir olguda desatürasyon görülmedi. Kontrol grubunda desatürasyon görülme oranı, hasta grubundan anlamlı olarak daha yüksekti (p<0,05). Hasta grubunda daha yüksek oranda sözel-taktil uyarı (STU) uygulandığı görüldü (p<0,05). İki grup arasında hipoksemi, bradikardi, taşikardi ve yapılan diğer müdahaleler yönünden anlamlı fark görülmedi. Hasta grubundaki olguların %67,5’inde (27/40) düşük EtCO2, %5’inde (2/40) yüksek EtCO2, %27,5’inde (11/40) apne, %37,5’inde (15/40) dikkat edilmesi gereken IPI değeri, %32,5’inde (13/40) müdahale edilmesi gereken IPI değeri görüldü. Dikkat edilmesi gereken IPI değerleri ile STU uygulanması (p<0,05) arasında, müdahale gerektiren durum ile apne ve bradipne gelişimi, STU, jaw-thrust manevrası (JTM), head-tilt manevrası (HTM) uygulanması arasında anlamlı ilişki saptandı. Hipoksemi gelişiminin görüldüğü yalnız bir hastada IPI 1-4 aralığındaydı. Sedatize ERKP olgularında EtCO2, apne ve IPI parametrelerinin anlık takibi ile solunum depresyonu önceden tanınabilir. Rutin monitörizasyona iii kapnografinin eklenmesi ile sedatize ERKP olgularında oksijen desatürasyonu gelişimi azalabilir.
Our aim in our study is to evaluate the effect of capnography monitorization in addition to routine monitorization on oxygen desaturation, hypoxemia and other vital parameters in patients undergoing ERCP under sedation. Eighty patients aged 18 and over who underwent ERCP with sedation were included in our study. Cases were divided into two groups: a group who underwent both routine and capnographic monitorization and a control group who only underwent routine monitorization. Presence of desaturation, hypoxemia, tachycardia, bradycardia and maneuvers for airway management are compared both quantitively and qualitatively between these two groups. Increase and decrease in end-tidal carbondioxide (EtCO2) levels, hypoxemia, desaturation, Integrated Pulmonary Index (IPI) levels requiring attention (5-7) and intervention (1-4) were determined in experiment group, frequencies and possible relations between each of them and other paramaters were assessed. No desaturation was observed in patient group. Prevalance of desaturation was significantly higher in control group compared to patient group (p<0,05). In patient group, more verbal-tactile stimulation was performed (p<0,05). There was no significant difference between groups, regarding hypoxemia, bradycardia, tachycardia and other maneuvers. In patient group, %67,5 of patients (27/40) had low EtCO2, %5 (2/40) had high EtCO2, %27,5 (11/40) had apnea, %37,5 (15/40) had IPI scores requiring attention and %32,5 (13/40) had IPI scores requiring intervention. In one patient who developed hypoxemia, IPI was in 1-4 interval. A statistically significant relationship was found between IPI scores requiring attention and verbal-tactile stimulation (p<0,05). IPI scores requiring intervention were significantly related to apnea-bradypnea development, verbal-tactile stimulation, jaw-thrust maneuver (JTM), head-tilt maneuver (HTM) also (p<0,05). v In ERCP patients who are sedated, respiratory depression can be recognised early with close monitorization of EtCO2, apnea and IPI parameters. Additional usage of capnography can reduce the risk of oxygen desaturation in sedatised ERCP patients.
Our aim in our study is to evaluate the effect of capnography monitorization in addition to routine monitorization on oxygen desaturation, hypoxemia and other vital parameters in patients undergoing ERCP under sedation. Eighty patients aged 18 and over who underwent ERCP with sedation were included in our study. Cases were divided into two groups: a group who underwent both routine and capnographic monitorization and a control group who only underwent routine monitorization. Presence of desaturation, hypoxemia, tachycardia, bradycardia and maneuvers for airway management are compared both quantitively and qualitatively between these two groups. Increase and decrease in end-tidal carbondioxide (EtCO2) levels, hypoxemia, desaturation, Integrated Pulmonary Index (IPI) levels requiring attention (5-7) and intervention (1-4) were determined in experiment group, frequencies and possible relations between each of them and other paramaters were assessed. No desaturation was observed in patient group. Prevalance of desaturation was significantly higher in control group compared to patient group (p<0,05). In patient group, more verbal-tactile stimulation was performed (p<0,05). There was no significant difference between groups, regarding hypoxemia, bradycardia, tachycardia and other maneuvers. In patient group, %67,5 of patients (27/40) had low EtCO2, %5 (2/40) had high EtCO2, %27,5 (11/40) had apnea, %37,5 (15/40) had IPI scores requiring attention and %32,5 (13/40) had IPI scores requiring intervention. In one patient who developed hypoxemia, IPI was in 1-4 interval. A statistically significant relationship was found between IPI scores requiring attention and verbal-tactile stimulation (p<0,05). IPI scores requiring intervention were significantly related to apnea-bradypnea development, verbal-tactile stimulation, jaw-thrust maneuver (JTM), head-tilt maneuver (HTM) also (p<0,05). v In ERCP patients who are sedated, respiratory depression can be recognised early with close monitorization of EtCO2, apnea and IPI parameters. Additional usage of capnography can reduce the risk of oxygen desaturation in sedatised ERCP patients.
Description
Keywords
Endoskopik retrograd kolanjio pankreatografi, End-tidal karbondioksit, EtCO2, ERKP, Sedasyon, Kapnografi, Endoscopic retrograde cholangio pancreatography, End-tidal carbondioxide, ERCP, Sedation, Capnography
Citation
Gökce, M. (2021). Endoskopik retrograd kolanjio pankreatografi (ERKP) uygulanan olguların güvenli sedasyonunda kapnografinin rolü. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.