Faculty Collaboration Database

Inadequacy of Pulse Oximetry in the Catheterization Laboratory. An Exploratory Study Monitoring Respiratory Status Using Arterial Blood Gases during Cardiac Catheterization with Conscious Sedation. Cardiovasc Revasc Med 2019 Jun;20(6):461-467

Date

08/14/2018

Pubmed ID

30100406

DOI

10.1016/j.carrev.2018.07.027

Scopus ID

2-s2.0-85051054503 (requires institutional sign-in at Scopus site)   2 Citations

Abstract

BACKGROUND: Benzodiazepines and opioids are commonly used for conscious sedation (CS) in cardiac catheterization laboratory (CCL) patients. Both drugs are known to predispose to hypoxemia, apnea and decreased responsiveness to PCO₂, resulting in decreased arterial pH and PO₂, as well as increased PCO₂. We want to determine the effects of CS on arterial blood gas (ABG) in CCL patient, and identify if pulse oximetry monitoring is adequate.

METHODS: We enrolled 18 subjects undergoing elective catheterization. Measurement of ABGs at one-minute intervals was done from the moment of arterial access until case end. The results of ABGs were not available to the clinician who administered sedation. Relationships of pH, PCO₂, PaO₂ and SaO₂ were studied by plotting time series graphs. Significant changes were defined as pH <7.30, SaO₂ < 90, and PCO₂ > 50 mmHg.

RESULTS: No significant change in pH, PCO₂, PaO₂ and SaO₂ was noted in 4/18 (22%) subjects. A significant drop in SaO₂ was noted in 4/18 (22%). A significant change in PCO₂ and/or pH was noted in 10/18 (55%) cases. Among the 16 (16/18) subjects receiving supplemental oxygen, 7 (7/18, 39%) had no drop in SaO₂, but developed respiratory acidosis. At the end of the case, 5/18 (28%) subjects had respiratory acidosis with normal PaO₂.

CONCLUSION: Significant hypercarbia and acidosis occurred frequently in this small study during CS in patients undergoing cardiac catheterization. Relying on pulse oximetry alone especially with patients on supplemental oxygen may lead to failure in detecting respiratory acidosis in a significant number of patients.

Author List

Fanari Z, Mohammed AA, Bathina JD, Hodges DT, Doorey K, Gagliano N, Garratt KN, Weintraub WS, Doorey AJ

MESH terms used to index this publication - Major topics in bold

Acidosis, Respiratory
Aged
Aged, 80 and over
Blood Gas Analysis
Cardiac Catheterization
Conscious Sedation
Female
Humans
Hypnotics and Sedatives
Male
Middle Aged
Monitoring, Ambulatory
Oximetry
Predictive Value of Tests
Prospective Studies
Reproducibility of Results
Respiration
Risk Factors
Time Factors