The utility of high-flow oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial.

Author(s): Deitch K, Chudnofsky CR, Dominici P, Latta D, Salamanca Y

Affiliation(s): Albert Einstein Medical Center, Philadelphia, PA, USA. deitchk@einstein.edu

Publication date & source: 2011-10, Ann Emerg Med., 58(4):360-364.e3. Epub 2011 Jun 15.

Publication type: Research Support, Non-U.S. Gov't

STUDY OBJECTIVE: We 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. METHODS: We 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. RESULTS: We 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). CONCLUSION: High-flow oxygen reduces the frequency of hypoxia during ED propofol sedation in adults. Copyright (c) 2011 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.