PMID- 34740888
OWN - NLM
STAT- MEDLINE
DCOM- 20221124
LR  - 20221124
IS  - 1472-0213 (Electronic)
IS  - 1472-0205 (Linking)
VI  - 39
IP  - 12
DP  - 2022 Dec
TI  - Cerebral oximetry monitoring using near-infrared spectroscopy during adult 
      procedural sedation: a preliminary study.
PG  - 882-887
LID - 10.1136/emermed-2020-210802 [doi]
AB  - BACKGROUND AND OBJECTIVES: We sought to evaluate the effect of adult procedural 
      sedation on cerebral oxygenation measured by near-infrared spectroscopy (rSo(2) 
      levels), and to assess whether respiratory depression occurring during procedural 
      sedation was associated with decreases in cerebral oxygenation. METHODS: We 
      performed a prospective, observational preliminary study on a convenience sample 
      of adult patients (>18 years) undergoing unscheduled procedural sedation in the 
      ED from August 2017 to September 2018 at Hennepin County Medical Center in 
      Minneapolis, Minnesota. The primary outcome measures were rSo(2) values by level 
      of sedation achieved and the incidence of cerebral hypoxaemia during procedural 
      sedation (absolute rSo(2) </=60 or decrease >/=20% from baseline). The secondary 
      outcome is the decrease in rSo(2) during episodes of respiratory adverse events 
      (AEs), defined by respiratory depression requiring supportive airway measures. 
      RESULTS: We enrolled 100 patients (53% female). The median (IQR) rSo(2) values 
      (%) by each level of sedation achieved on the Observer Assessment of Alertness 
      and Sedation (OAAS) scale 1-5, respectively, were 74 (69-79), 74 (70-79), 74 
      (69-79), 75 (69-80), 72 (68-76). The incidence of cerebral hypoxaemia at any 
      point within the sedation (absolute rSo(2) <60%) was 10/100 (10%); 2 out of 10 
      had rSo(2) reduction more than 20% from baseline value; the median (IQR) observed 
      minimum rSo(2) in these patients was 58 (56-59). We observed respiratory 
      depression in 65 patients via standard monitoring; of these, 39 (60%) required at 
      least one supportive airway measure, meeting the definition of a respiratory AE. 
      During these AEs, 15% (6/39) demonstrated cerebral hypoxaemia with a median (IQR) 
      minimum rSo(2) of 58 (57-59). Four patients (4%) had cerebral hypoxaemia without 
      a respiratory AE. CONCLUSION: Cerebral oximetry may represent a useful tool for 
      procedural sedation safety research to detect potential subclinical changes that 
      may be associated with risk, but appears neither sensitive nor specific for 
      routine use in clinical practice.
CI  - (c) Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Carlson, Krista R
AU  - Carlson KR
AUID- ORCID: 0000-0002-0285-8356
AD  - Internal Medicine, US Army Brooke Army Medical Center, Fort Sam Houston, Texas, 
      USA krista.carlson.kc@gmail.com.
FAU - Driver, Brian E
AU  - Driver BE
AD  - Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
FAU - Satpathy, Rajesh
AU  - Satpathy R
AD  - Department of Biostatistics, The George Washington University Milken Institute of 
      Public Health, Washington, District of Columbia, USA.
FAU - Miner, James R
AU  - Miner JR
AD  - Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota, USA.
LA  - eng
PT  - Journal Article
DEP - 20211105
PL  - England
TA  - Emerg Med J
JT  - Emergency medicine journal : EMJ
JID - 100963089
RN  - S88TT14065 (Oxygen)
SB  - IM
MH  - Adult
MH  - Humans
MH  - Female
MH  - Male
MH  - *Oximetry/methods
MH  - Spectroscopy, Near-Infrared/methods
MH  - Cerebrovascular Circulation
MH  - Prospective Studies
MH  - *Respiratory Insufficiency
MH  - Hypoxia/etiology/prevention & control
MH  - Oxygen
OTO - NOTNLM
OT  - anaesthesia
OT  - emergency department
OT  - respiratory
COIS- Competing interests: None declared.
EDAT- 2021/11/07 06:00
MHDA- 2022/11/25 06:00
CRDT- 2021/11/06 05:36
PHST- 2020/10/14 00:00 [received]
PHST- 2021/10/22 00:00 [accepted]
PHST- 2021/11/07 06:00 [pubmed]
PHST- 2022/11/25 06:00 [medline]
PHST- 2021/11/06 05:36 [entrez]
AID - emermed-2020-210802 [pii]
AID - 10.1136/emermed-2020-210802 [doi]
PST - ppublish
SO  - Emerg Med J. 2022 Dec;39(12):882-887. doi: 10.1136/emermed-2020-210802. Epub 2021 
      Nov 5.