Continuous negative external pressure (cNEP) reduces respiratory impairment during screening colonoscopy: a pilot study.
OBJECTIVE
Drugs administered during gastrointestinal procedures cause increased collapsibility of the upper airway, which may lead to respiratory impairment. We evaluated the ability of continuous negative external pressure (cNEP) to lessen respiratory impairment during screening colonoscopy.


METHODS
The initial 24 patients served as controls, while the next 30 received cNEP. cNEP was delivered by a soft silicone collar placed over the anterior neck. The primary endpoint was the frequency of respiratory impairment, defined as either: (i) a decline from baseline of > 4 % in oxygen saturation, or (ii) apnea lasting ≥ 20 seconds.


RESULTS
Mean respiratory impairment episodes were 3.50 in the no-cNEP group vs. 1.92 in the cNEP group, a reduction of 45 % (P = 0.022). Apneas ≥ 20 seconds occurred in 74 % of the no-cNEP group and 28 % of the cNEP group (P = 0.002). While 42 % of the no-cNEP group required increased supplemental oxygen, this was true for only 10 % of the cNEP group (P = 0.01). cNEP adverse events were minimal.


CONCLUSIONS
During screening colonoscopy, sedation-related respiratory impairment is significantly reduced by cNEP.ClinicalTrials.gov NCT01895062.
Division of Gastroenterology, Scripps Green Hospital, La Jolla, California, USA.
Susan S
SS
Kais
Endpoint, LLC, Bainbridge Island, Washington, USA.
Kenneth B
KB
Klein
Department of Medicine, University of California, San Diego, California, USA.
Richard M
RM
Rose
Division of Gastroenterology, Scripps Green Hospital, La Jolla, California, USA.
Sarah
S
Endemann
Division of Gastroenterology, Scripps Green Hospital, La Jolla, California, USA.
Walter J
WJ
Coyle
D000328:Adult; D000368:Aged; D000402:Airway Obstruction / Q000139:chemically induced / Q000517:prevention & control*; D001049:Apnea / Q000139:chemically induced / Q000517:prevention & control*; D003113:Colonoscopy / Q000295:instrumentation*; D054810:Deep Sedation / Q000009:adverse effects*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D010100:Oxygen / Q000097:blood; D010865:Pilot Projects; D011312:Pressure; D012131:Respiratory Insufficiency / Q000139:chemically induced / Q000517:prevention & control*; D014618:Vacuum
D010100:Oxygen