• Kenneth Deitch, Carl R Chudnofsky, Paul Dominici, Daniel Latta, and Yidy Salamanca.
• Albert Einstein Medical Center, Philadelphia, PA, USA. deitchk@einstein.edu
• Ann Emerg Med. 2011 Oct 1;58(4):360-364.e3.

Study ObjectiveWe determine whether high-flow oxygen reduces the incidence of hypoxia by 20% in adults receiving propofol for emergency department (ED) sedation compared with room air.MethodsWe randomized adults to receive 100% oxygen or compressed air at 15 L/minute by nonrebreather mask for 5 minutes before and during propofol procedural sedation. We administered 1.0 mg/kg of propofol, followed by 0.5 mg/kg boluses until the patient was adequately sedated. Physicians and patients were blinded to the gas used. Hypoxia was defined a priori as an oxygen saturation less than 93%; respiratory depression was defined as an end tidal CO(2) greater than 50 mm Hg, a 10% absolute change from baseline, or loss of waveform.ResultsWe noted significantly less hypoxia in the 59 patients receiving high-flow oxygen compared with the 58 receiving compressed air (19% versus 41%; P=.007; difference 23%; 95% confidence interval 6% to 38%). Respiratory depression was similar between groups (51% versus 48%; difference 2%; 95% confidence interval -15% to 22%). We observed 2 adverse events in the high-flow group (1 hypotension, 1 bradycardia) and 2 in the compressed air group (1 assisted ventilation, 1 hypotension).ConclusionHigh-flow oxygen reduces the frequency of hypoxia during ED propofol sedation in adults.Copyright © 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

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