title: The value of Integrated Pulmonary Index (IPI) monitoring during endoscopies in children.
abstract: The Integrated Pulmonary Index (IPI) is an algorithm included in commercially available monitors that constitutes a representation of 4 parameters: EtCO2, RR, SpO2 and PR. The IPI index has been validated for adults and children older than 1 year of age. In this study we aimed to study the value of IPI monitoring during pediatric endoscopic procedures. Our data consisted of 124 measurements of 109 patients undergoing different procedures (upper endoscopy 84 patients, colonoscopy 6 patients, both 9 patients). The data was divided into 3 groups based on the drug type used: propofol only, 5 patients (group 1); propofol & midazolam, 89 patients (group 2); propofol, midazolam and Fentanyl, 15 patients (group 3). Patients in group 2 and 3 had significantly higher IPI levels than group 1. Significantly lower IPI values were found between ages 4-6 compared to 7-12 years old. High midazolam dose was associated with lower IPI levels during the procedure. No significant differences were found for propofol doses. Patients who had an anesthetist present had lower IPI levels during the procedure compared to those who did not. No differences were noted between the different procedures. IPI alerted all apnea episodes (58 events, IPI = 1) and hypoxia (26 events, IPI ≤ 3) episodes, whereas pulse oximetry captured only the hypoxia episodes (IPI sensitivity = 1, specificity 0.98, positive predictive value 0.95). Younger patient age, use of propofol alone, higher midazolam doses and presence of anesthetist are all associated with lower IPI levels.
authors: Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.|Technion Faculty of the Medicine, Haifa, Israel.
authors: Jamal
authors: J
authors: Garah
authors: Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.|Technion Faculty of the Medicine, Haifa, Israel.
authors: Orly Eshach
authors: OE
authors: Adiv
authors: Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel.|Technion Faculty of the Medicine, Haifa, Israel.
authors: Irit
authors: I
authors: Rosen
authors: Pediatric Gastroenterology and Nutrition Unit, Meyer Children's Hospital of Haifa, Rambam Medical Center, POB 9602, Haifa, 31096, Israel. shaoul_r@012.net.il.|Technion Faculty of the Medicine, Haifa, Israel. shaoul_r@012.net.il.
authors: Ron
authors: R
authors: Shaoul
mesh_terms: D000293:Adolescent; D000465:Algorithms; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D019296:Capnography; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004724:Endoscopy / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D007040:Hypoventilation / Q000175:diagnosis / Q000209:etiology; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology; D007223:Infant; D008297:Male; D008874:Midazolam / Q000008:administration & dosage / Q000009:adverse effects; D008991:Monitoring, Physiologic / Q000379:methods* / Q000706:statistics & numerical data; D010092:Oximetry; D015742:Propofol / Q000008:administration & dosage / Q000009:adverse effects; D012143:Respiratory Physiological Phenomena / Q000187:drug effects; D056152:Respiratory Rate
chemical_list: D018686:Anesthetics, Intravenous; D008874:Midazolam; D005283:Fentanyl; D015742:Propofol
keywords: Children; End tidal CO2; Endoscopy; Monitoring; Safety; Sedation