title: Does pulse oximetry accurately monitor a patient's ventilation during sedated endoscopy under oxygen supplementation?
abstract: BACKGROUND
  Pulse oximetry (SpO2) measures oxygen saturation but not alveolar ventilation. Its failure to detect alveolar hypoventilation during sedated endoscopy under oxygen supplementation has been reported. The aim of this study was to measure the masking effect of oxygen supplementation in SpO2 when alveolar hypoventilation develops during sedated endoscopy.
  
  
  METHODS
  A total of 70 patients undergoing sedated diagnostic colonoscopy were randomly divided into two groups - oxygen supplementation group (n = 35) and room air breathing group (n = 35). SpO2 and end-tidal carbon dioxide (etCO2) were measured by non-intubated capnography during the procedure for all the patients.
  
  
  RESULTS
  The rise of etCO2 caused by alveolar hypoventilation was comparable in the two groups after sedation. SpO2 was significantly higher in the oxygen supplementation group than in the room air breathing group (98.6% ± 1.4% vs. 93.1% ± 2.9%; p < 0.001) at peak etCO2, and oxygen supplementation caused SpO2 to be overestimated by greater than 5% when compared with room air. SpO2 at peak etCO2 was reduced from the baseline before sedation for the oxygen supplementation and room air breathing groups by 0.5% ± 1.1% and 4.1% ± 3.1%, respectively (p < 0.001).
  
  
  CONCLUSIONS
  SpO2 alone is not adequate for monitoring alveolar ventilation during sedated endoscopy under oxygen supplementation due to possible delays in detecting alveolar hypoventilation in patients. Even if SpO2 decreases by only 1% during the procedure and its level remains near 100%, physicians should consider the onset of severe alveolar hypoventilation, which requires immediate intervention.
authors.affiliation: Division of Gastroenterology and Hepatology, Jikei University Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba 277-8567, Japan. endosc-arakawa@jikei.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Arakawa
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Kaise
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sumiyama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Saito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Suzuki
authors.forename: Hisao
authors.initials: H
authors.lastname: Tajiri
mesh_terms: D000328:Adult; D000368:Aged; D002245:Carbon Dioxide / Q000032:analysis; D003113:Colonoscopy; D016292:Procedural Sedation; D004724:Endoscopy; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D010092:Oximetry / Q000379:methods*; D010100:Oxygen / Q000008:administration & dosage*; D012121:Respiration, Artificial
chemical_list: D002245:Carbon Dioxide; D010100:Oxygen