Clin Endosc.  2024 Mar;57(2):196-202. 10.5946/ce.2023.010.

Impact of a simple non-invasive nasal mask device on intraprocedural hypoxemia in overweight individuals undergoing upper gastrointestinal endoscopy with sedation provided by a non-anesthesiologist provider

• Drews J
• Harder J
• Kaiser H
• Soenarjo M
• Spahlinger D
• Wohlmuth P
• Wirtz S
• Eberhardt R
• Bornitz F
• Bunde T
• von Hahn T

• KMID: 2553756
• DOI: http://doi.org/10.5946/ce.2023.010

Abstract

Background/Aims
Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies.
Methods
We compared overweight patients (body mass index >25 kg/m2) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes.
Results
We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO2] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO2 <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO2 and the lowest SpO2 recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008).
Conclusions
Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.

Keyword

Hypoxemia; Safety; Sedation; Upper gastrointestinal endoscopy

Figure

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  Fig. 1. Nasal positive airway pressure mask used in this study during upper gastrointestinal endoscopy. SuperNO2VA Nasal Positive Airway Pressure Ventilation System (Vyaire). (A) Positioning and attachment of the device. (B) Upper gastrointestinal endoscopy with the nasal positive airway pressure mask in place.

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  Fig. 2. Oxygen saturation before and during sedation. Oxygen saturation (SpO2) before sedation (baseline) and lowest value during sedation (lowest) in patients with nasal cannula compared to those in the nasal positive airway pressure (PAP) mask cohort. Within each group, differences were tested for statistical significance using Wilcoxon signed ranks test; the difference in delta-SpO2 between the groups was tested using two-sided Wilcoxon-Mann-Whitney test.

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