The Science Journal of the American Association for Respiratory Care

2012 OPEN FORUM Abstracts

FLEXIBLE FIBEROPTIC BRONCHOSCOPY: VENTILATION MONITORING USING INTEGRATED PULMONARY INDEX VERSUS STANDARD MONITORING PROCEDURES.

Stephanie A. Herrnreiter, David L. Vines, Mark A. Yoder; Respiratory Therapy Master Program, Rush University, Chicago, IL

Background: Conscious or moderate sedation is common practice during invasive procedures. The best approach to monitor ventilation is end-tidal carbon dioxide (EtCO2). EtCO2 provides a noninvasive, “real-time” measurement of a patient’s ventilation. The purpose of this study is to investigate if the IPI decreases during bronchoscopy before physician or staff directed intervention, and to determine if EtCO2 remains unaltered from a baseline before the procedure to when the bronchoscope is at the level of the vocal cords. Methods: This was an observational study with no blinding and was conducted at Rush University Medical Center, Chicago. Subjects provided written consent before their procedure to be enrolled in the study. Eight patients were enrolled in the study but complete data was collected only during 6 bronchoscopies. Microstream bite blocks were used to monitor subjects and deliver oxygen. The alarms were silenced on the Microstream 20 monitoring device so physicians would not be alerted. Results: The mean age of the participants was 53.8 years-old, with the youngest 29 years-old and the oldest 83 years-old. Four subjects had a minimum IPI below 3 and there was no need for intervention. The lowest recorded EtCO2 value throughout both pre-procedure and procedure period was 0mmHg. The greatest decrease in EtCO2 from pre-procedure to during procedure was from 45mmHg to 25mmHg. EtCO2 decreased during two procedures after the scope was inserted and increased during four. A complete list of observed vital signs and alarm activation can be found in the attached table. Conclusion: Practitioner intervention occurred twice during all 6 procedures combined. These interventions were not preceded by a low IPI reading. Practitioner interventions included increasing oxygen flow to the subject, terminating the procedure to place the subject on a non-rebreather mask, and delivering a dose of versed in response to agitation and increased pulse rate. EtCO2 values did fluctuate from before insertion of the bronchoscope to after. Sponsored Research - None Silenced Urgent Alarm Activation During Procedure