Inadequacy of Pulse Oximetry in the Catheterization Laboratory. An Exploratory Study Monitoring Respiratory Status Using Arterial Blood Gases during Cardiac Catheterization with Conscious Sedation.

MedStar author(s):
Citation: Cardiovascular Revascularization Medicine. 20(6):461-467, 2019 06.PMID: 30100406Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Acidosis, Respiratory/di [Diagnosis] | *Blood Gas Analysis | *Cardiac Catheterization | *Conscious Sedation/ae [Adverse Effects] | *Hypnotics and Sedatives/ae [Adverse Effects] | *Monitoring, Ambulatory/mt [Methods] | *Oximetry | *Respiration/de [Drug Effects] | Acidosis, Respiratory/bl [Blood] | Acidosis, Respiratory/ci [Chemically Induced] | Acidosis, Respiratory/pp [Physiopathology] | Aged | Aged, 80 and over | Female | Humans | Hypnotics and Sedatives/ad [Administration & Dosage] | Male | Middle Aged | Predictive Value of Tests | Prospective Studies | Reproducibility of Results | Risk Factors | Time FactorsYear: 2019Local holdings: Available in print through MWHC library: 2002 - presentISSN:
  • 1878-0938
Name of journal: Cardiovascular revascularization medicine : including molecular interventionsAbstract: BACKGROUND: Benzodiazepines and opioids are commonly used for conscious sedation (CS) in cardiac catheterization laboratory (CCL) patients. Both drugs are known to predispose to hypoxemia, apnea and decreased responsiveness to PCO<sub>2</sub>, resulting in decreased arterial pH and PO<sub>2</sub>, as well as increased PCO<sub>2</sub>. We want to determine the effects of CS on arterial blood gas (ABG) in CCL patient, and identify if pulse oximetry monitoring is adequate.CONCLUSION: Significant hypercarbia and acidosis occurred frequently in this small study during CS in patients undergoing cardiac catheterization. Relying on pulse oximetry alone especially with patients on supplemental oxygen may lead to failure in detecting respiratory acidosis in a significant number of patients.Copyright (c) 2018 Elsevier Inc. All rights reserved.METHODS: We enrolled 18 subjects undergoing elective catheterization. Measurement of ABGs at one-minute intervals was done from the moment of arterial access until case end. The results of ABGs were not available to the clinician who administered sedation. Relationships of pH, PCO<sub>2</sub>, PaO<sub>2</sub> and SaO<sub>2</sub> were studied by plotting time series graphs. Significant changes were defined as pH <7.30, SaO<sub>2</sub><90, and PCO<sub>2</sub>>50mmHg.RESULTS: No significant change in pH, PCO<sub>2</sub>, PaO<sub>2</sub> and SaO<sub>2</sub> was noted in 4/18 (22%) subjects. A significant drop in SaO<sub>2</sub> was noted in 4/18 (22%). A significant change in PCO<sub>2</sub> and/or pH was noted in 10/18 (55%) cases. Among the 16 (16/18) subjects receiving supplemental oxygen, 7 (7/18, 39%) had no drop in SaO<sub>2</sub>, but developed respiratory acidosis. At the end of the case, 5/18 (28%) subjects had respiratory acidosis with normal PaO<sub>2</sub>.All authors: Bathina JD, Doorey AJ, Doorey K, Fanari Z, Gagliano N, Garratt KN, Hodges DT, Mohammed AA, Weintraub WSOriginally published: Cardiovascular Revascularization Medicine. 2018 Aug 01Fiscal year: FY2019Digital Object Identifier: Date added to catalog: 2018-08-16
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 30100406 Available 30100406

Available in print through MWHC library: 2002 - present

BACKGROUND: Benzodiazepines and opioids are commonly used for conscious sedation (CS) in cardiac catheterization laboratory (CCL) patients. Both drugs are known to predispose to hypoxemia, apnea and decreased responsiveness to PCO<sub>2</sub>, resulting in decreased arterial pH and PO<sub>2</sub>, as well as increased PCO<sub>2</sub>. We want to determine the effects of CS on arterial blood gas (ABG) in CCL patient, and identify if pulse oximetry monitoring is adequate.

CONCLUSION: Significant hypercarbia and acidosis occurred frequently in this small study during CS in patients undergoing cardiac catheterization. Relying on pulse oximetry alone especially with patients on supplemental oxygen may lead to failure in detecting respiratory acidosis in a significant number of patients.

Copyright (c) 2018 Elsevier Inc. All rights reserved.

METHODS: We enrolled 18 subjects undergoing elective catheterization. Measurement of ABGs at one-minute intervals was done from the moment of arterial access until case end. The results of ABGs were not available to the clinician who administered sedation. Relationships of pH, PCO<sub>2</sub>, PaO<sub>2</sub> and SaO<sub>2</sub> were studied by plotting time series graphs. Significant changes were defined as pH <7.30, SaO<sub>2</sub><90, and PCO<sub>2</sub>>50mmHg.

RESULTS: No significant change in pH, PCO<sub>2</sub>, PaO<sub>2</sub> and SaO<sub>2</sub> was noted in 4/18 (22%) subjects. A significant drop in SaO<sub>2</sub> was noted in 4/18 (22%). A significant change in PCO<sub>2</sub> and/or pH was noted in 10/18 (55%) cases. Among the 16 (16/18) subjects receiving supplemental oxygen, 7 (7/18, 39%) had no drop in SaO<sub>2</sub>, but developed respiratory acidosis. At the end of the case, 5/18 (28%) subjects had respiratory acidosis with normal PaO<sub>2</sub>.

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