The Utility of Supplemental Oxygen During Emergency Department Procedural Sedation and Analgesia With Midazolam and Fentanyl: A Randomized, Controlled Trial
Presented as an abstract poster at the Research Forum, American College of Emergency Physicians, September 2005, Washington, DC.
Received 24 October 2005; received in revised form 9 March 2006 and 26 May 2006; accepted 12 June 2006. published online 19 September 2006.
Refers to article:
Research Advances in Procedural Sedation and Analgesia
, 06 November 2006
Steven M. Green
Annals of Emergency Medicine
January 2007 (Vol. 49, Issue 1, Pages 31-36) Full Text |
Full-Text PDF (100 KB)
Study objective
To determine whether supplemental oxygen reduces the incidence of hypoxia by 20% in study patients receiving midazolam and fentanyl for emergency department procedural sedation and analgesia.
Methods
Patients were randomized to receive either supplemental oxygen or compressed air by nasal cannula at 2 L per minute. Physicians were blinded to the gas used and end-tidal carbon dioxide (etco2) data. Respiratory depression was defined a priori as oxygen saturation less than 90%, etco2 level greater than 50 mm Hg, an absolute change from baseline of 10 mm Hg, or loss of the etco2 waveform.
Results
Of the 80 patients analyzed, 44 received supplemental oxygen and 36 received compressed air. Twenty supplemental oxygen patients and 19 compressed air patients met at least 1 criterion for respiratory depression. Six supplemental oxygen patients and 5 compressed air patients experienced hypoxia (P=.97; effect size 0%; 95% confidence interval –15% to +15%). Fourteen patients in each group met etco2 criteria for respiratory depression but were not hypoxic. Physicians identified respiratory depression in 8 of 11 patients who became hypoxic and 0 of 28 patients who met etco2 criteria for respiratory depression but who did not become hypoxic. There were no adverse events.
Conclusion
Supplemental oxygen did not reduce (or trend toward reducing) the incidence of hypoxia in patients moderately sedated with midazolam and fentanyl. However, our lower-than-expected rate of hypoxia limits the power of this comparison. Blinded capnography frequently identified respiratory depression undetected by the treating physicians.
Department of Emergency Medicine, Albert Einstein Medical Center, Philadelphia, PA.
Address for correspondence: Ken Deitch, DO, Department of Emergency Medicine, Albert Einstein Medical Center, Korman B-6, 5501 Old York Road, Philadelphia, PA 19141; 215-888-8403, fax 215-456-8502.
Supervising editor: Steven M. Green, MD
Author contributions: KD and CRC conceived the study and designed the trial. KD, CRC, and PD supervised the conduct of the trial and data collection. KD, CRC, and PD managed the data, including quality control. PD provided statistical advice on study design and analyzed the data. KD drafted the manuscript, and all authors contributed substantially to its revision. KD takes responsibility for the paper as a whole.
Funding and support: The authors report this study did not receive any outside funding or support.
ABSTRACT