title: The utility of high-flow oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial.
abstract: 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).
  
  
  CONCLUSIONS
  High-flow oxygen reduces the frequency of hypoxia during ED propofol sedation in adults.
authors.affiliation: Albert Einstein Medical Center, Philadelphia, PA, USA. deitchk@einstein.edu
authors.forename: Kenneth
authors.initials: K
authors.lastname: Deitch
authors.forename: Carl R
authors.initials: CR
authors.lastname: Chudnofsky
authors.forename: Paul
authors.initials: P
authors.lastname: Dominici
authors.forename: Daniel
authors.initials: D
authors.lastname: Latta
authors.forename: Yidy
authors.initials: Y
authors.lastname: Salamanca
mesh_terms: D000328:Adult; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D000860:Hypoxia / Q000139:chemically induced / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000517:prevention & control; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D015742:Propofol