• F A Michael, D Hessz, C Graf, C Zimmer, S Nour, M Jung, J Kloka, M Knabe, C Welsch, I Blumenstein, G Dultz, F Finkelmeier, D Walter, U Mihm, N Lingwal, S Zeuzem, J Bojunga, and M Friedrich-Rust.
• Goethe University Frankfurt, University Hospital, Department of Internal Medicine 1, Frankfurt am Main, Germany. Electronic address: fmichael@med.uni-frankfurt.de.
• J Clin Anesth. 2024 Jun 1; 94: 111403111403.

Study ObjectiveTo assess the efficacy of an ECG-based method called thoracic impedance pneumography to reduce hypoxic events in endoscopy.DesignThis was a single center, 1:1 randomized controlled trial.SettingThe trial was conducted during the placement of percutaneous endoscopic gastrostomy (PEG).Patients173 patients who underwent PEG placement were enrolled in the present trial. Indication was oncological in most patients (89%). 58% of patients were ASA class II and 42% of patients ASA class III.InterventionsPatients were randomized in the standard monitoring group (SM) with pulse oximetry and automatic blood pressure measurement or in the intervention group with additional thoracic impedance pneumography (TIM). Sedation was performed with propofol by gastroenterologists or trained nurses.MeasurementsHypoxic episodes defined as SpO2 < 90% for >15 s were the primary endpoint. Secondary endpoints were minimal SpO2, apnea >10s/>30s and incurred costs.Main ResultsAdditional use of thoracic impedance pneumography reduced hypoxic episodes (TIM: 31% vs SM: 49%; p = 0.016; OR 0.47; NNT 5.6) and elevated minimal SpO2 per procedure (TIM: 90.0% ± 8.9; SM: 84.0% ± 17.6; p = 0.007) significantly. Apnea events >10s and > 30s were significantly more often detected in TIM (43%; 7%) compared to SM (1%; 0%; p < 0.001; p = 0.014) resulting in a time advantage of 17 s before the occurrence of hypoxic events. As a result, adjustments of oxygen flow were significantly more often necessary in SM than in TIM (p = 0.034) and assisted ventilation was less often needed in TIM (2%) compared with SM (9%; p = 0.053). Calculated costs for the additional use of thoracic impedance pneumography were 0.13$ (0.12 €/0.11 £) per procedure.ConclusionsAdditional thoracic impedance pneumography reduced the quantity and extent of hypoxic events with less need of assisted ventilation. Supplemental costs per procedure were negligible.Key Wordsthoracic impedance pneumography, capnography, sedation, monitoring, gastrointestinal endoscopy, percutaneous endoscopic gastrostomy.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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