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Rational: Preoxygenation is a standard procedure before (deep) sedation in the ED. However, there is literature suggesting that too much oxygen can be harmful. One potential detrimental effect is a decrease in cardiac output due to coronary vasoconstriction. So far, it is unknown if this effect is rate dependent and if it also occurs after only a short period of hyperoxia, as patients experience during procedural sedation pre-oxygenation.
Objective: To investigate if hyperoxia has a negative effect on Cardiac index (CI) in patients undergoing procedural sedation in the ED.
Methods: In patients needing sedation for a painful condition, non-invasive measurements of CI, stroke volume and total peripheral resistance are performed using the Clearsight non-invasive cardiac output monitoring system.. Measurements will be taken at baseline, after 1,2 and 5 minutes of 15L O2/min, and then after another 2 and 5 minutes of flush rate oxygen and during the subsequent sedation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Clearsight measurements | All patients presenting to the ED who have a painful condition for which procedural sedation is required will undergo Clearsight measurements |
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| Measure | Description | Time Frame |
|---|---|---|
| The change in cardiac output (L/min) after respectively 15L/min and flush rate preoxygenation in respect to baseline | Cardiac output is measured by Clearsight non invasive hemodynamic monitoring system; 3 baseline measurements are done separated by one minute intervals; subsequently 15L/min O2 is started. After 1,2 and 5 minutes, measurements are repeated. After 5 minutes, flush rate O2 is started. After 2 and 5 minutes, measurements are repeated. | at baseline, at 1,2,5 (15L),7 and 10 minutes (flush o2) |
| Measure | Description | Time Frame |
|---|---|---|
| The change in heart rate (BPM) after respectively 15L/min and flush rate preoxygenation in respect to baseline | 3 baseline measurements are done separated by one minute intervals; subsequently 15L/min O2 is started. After 1,2 and 5 minutes, measurements are repeated. After 5 minutes, flush rate O2 is started. After 2 and 5 minutes, measurements are repeated. | at baseline, at 1,2,5, (15L o2) and 7, 10 minutes (flush o2) |
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Inclusion Criteria:
Exclusion Criteria:
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- Patients presenting in the ED of the Medical Center Leeuwarden (MCL) who have a painful condition for which procedural sedation is required.
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| Name | Affiliation | Role |
|---|---|---|
| Ewoud ter Avest, MD, PhD | medical center leeuwarden | Principal Investigator |
| Renate Stolmeijer, MD | medical center leeuwarden | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Medical Center Leeuwarden | Leeuwarden | 8934AD | Netherlands |
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| ID | Term |
|---|---|
| D018496 | Hyperoxia |
| D002303 | Cardiac Output, Low |
| D004630 | Emergencies |
| ID | Term |
|---|---|
| D012818 | Signs and Symptoms, Respiratory |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D006331 | Heart Diseases |
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| the change in systolic blood pressure (mmHg) after respectively 15L/min and flush rate preoxygenation in respect to baseline | Systolic blood pressure is measured by Clearsight non invasive hemodynamic monitoring system; 3 baseline measurements are done separated by one minute intervals; subsequently 15L/min O2 is started. After 1,2 and 5 minutes, measurements are repeated. After 5 minutes, flush rate O2 is started. After 2 and 5 minutes, measurements are repeated. | at baseline, at 1,2,5 (15L o2) and 7, 10 minutes (flush o2) |
| The change in stroke volume (ml) after respectively 15L/min and flush rate preoxygenation in respect to baseline | Stroke volume is measured by Clearsight non invasive hemodynamic monitoring system; 3 baseline measurements are done separated by one minute intervals; subsequently 15L/min O2 is started. After 1,2 and 5 minutes, measurements are repeated. After 5 minutes, flush rate O2 is started. After 2 and 5 minutes, measurements are repeated. | at baseline, at 1,2,5 (15L o2) and 7, 10 minutes (flush o2) |
| the change in total peripheral vascular resistance after respectively 15L/min and flush rate preoxygenation in respect to baseline | Peripheral vascular resistance is measured by Clearsight non invasive hemodynamic monitoring system; 3 baseline measurements are done separated by one minute intervals; subsequently 15L/min O2 is started. After 1,2 and 5 minutes, measurements are repeated. After 5 minutes, flush rate O2 is started. After 2 and 5 minutes, measurements are repeated. | at baseline, at 1,2,5 (15L o2) and 7,10 minutes (flush o2) |
| The relation of the difference in CI with the occurrence of of haemodynamic sedation events | In case of apnea > 20 sec, low SBP <90 mmHg or >20% decrease in comparison to baseline, desaturation <92%, assess relation to change in cardiac output (L/min) during preoxygenation | at baseline, at 1,2,5 (15L o2) ,7 and 10 minutes (flush o2) |
| D002318 | Cardiovascular Diseases |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |