- This article proposes that modified manual chest compression (MMCC) may contribute to preventing and treating respiratory depression and hypoxemia in patients undergoing deep sedation for upper GI endoscopy.
- The study encompasses two randomized controlled trials. The first trial involves a preventive cohort, comprising two groups of 220 patients each, randomly assigned to either the intervention or control group.
- The second trial focuses on a therapeutic cohort, again with two groups of 72 patients each randomly assigned to either a control or treatment group.
- All patients are positioned in the left lateral decubitus posture and administered fentanyl/propofol for sedation with nasal O2. MMCC differs significantly from standard CPR chest compressions, involving 20 compressions per minute to the right lower chest wall with only 1/10th of the force used in standard CPR.
- In the Preventive group, MMCC (20 chest compressions per minute) is applied after anesthesia induction. In the Therapeutic group, if O2 saturation falls below 95%, the anesthesia professional increases oxygen flow and performs a jaw thrust to open the airway. Once the obstruction is relieved, MMCC is administered to the MMCC group, while the control group receives no MMCC. If SpO2 falls below 90% for > 1 minute, the gastroscope is removed, and mask ventilation is initiated. If hypoxemia persists, the patient is intubated and mechanically ventilated.
- Besides standard data points, the authors utilize infrared thermal imaging to evaluate airflow around the nose and mouth and ultrasound to assess diaphragmatic mobility.
- In the Preventive cohort, 26.1% of control group patients experience desaturation <95%, compared to only 14.4% in the MMCC group. Furthermore, Spo2 <90% is observed in 13.3% of the control group but only 5.56% in the MMCC group.
- In the therapeutic cohort, patients receiving MMCC exhibit significantly shorter durations with Spo2 <95% (40 vs. 91 seconds). The MMCC group also experiences fewer instances of SpO2 <90% compared to the control group (37.7% vs. 65.7%). Moreover, the control group necessitates stopping the procedure and removing the endoscope in 10.4% of cases, while none of the MMCC group requires such intervention.
- This study highlights a simple, non-invasive method to reduce hypoxemia incidence in patients undergoing upper GI endoscopy with deep sedation. The maneuver’s response is prompt and demands no additional equipment or hardware.
Summary of "Modified Manual Chest Compression for Prevention and Treatment of Respiratory Depression in Patients Under Deep Sedation During Upper Gastrointestinal Endoscopy: Two Randomized Controlled Trials"
Summary published February 12, 2024
