Comparing oxygen therapies for hypoxemia prevention during gastrointestinal endoscopy under procedural sedation: A systematic review and network meta-analysis - 11/09/24
, Weifeng Yao, (MD) a, ⁎ , Chaojin Chen, (MD) a, ⁎ Abstract |
Study objective |
Hypoxemia is the most frequent adverse event observed during gastrointestinal endoscopy under procedural sedation. An optimum oxygen therapy has still not been conclusively determined.
Design |
A systematic review and network meta-analysis of randomized clinical trials.
Setting |
Digestive Endoscopy Center.
Patients |
Adults (≥18 years old and of both sexes) during gastrointestinal endoscopy under procedural sedation.
Interventions |
Pubmed, MEDLINE, Web of Science, Embase, and Clinicaltrials.gov. were searched until June 30, 2023. Randomized clinical trials (RCTs) comparing any oxygen therapy with another oxygen therapy or with placebo (nasal cannula, NC) were included.
Measurement |
The primary outcome was the incidence of hypoxemia, defined as the pulse oxygen saturation (SpO2). Random-effects network meta-analyses were performed. Data are reported as odds ratios (OR), prediction intervals (PrI) and 95% CI. Bias risk was evaluated following the guidelines outlined by the Cochrane Collaboration. The quality of evidence was evaluated through the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
Main results |
We included 27 RCTs with a total of 7552 patients. Compared to the use of NC, non-invasive positive pressure ventilation (NIPPV) demonstrated superior efficacy in mitigating hypoxemia (NIPPV vs. NC, OR = 0.16, 95% CI: 0.08–0.31, 95% PrI: 0.06–0.41), followed by Wei nasal jet tube (WNJT) (WNJT vs. NC, OR = 0.17, 95% CI: 0.10–0.30, 95% PrI: 0.07–0.42). The efficacy for preventing hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > NC.
Conclusions |
During gastrointestinal endoscopy under procedural sedation, all other advanced oxygen therapies were found to be more efficacious than nasal cannula. NIPPV and WNJT appear to be the most efficacious oxygen therapy for preventing hypoxemia. Additionally, clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events.
Le texte complet de cet article est disponible en PDF.Highlights |
• | This is the first network meta-analysis that compares the effect of various oxygen therapy approaches for preventing hypoxemia in adults undergoing GI endoscopy under sedation. |
• | Non-invasive positive pressure ventilation (NIPPV) and Wei nasal jet tube (WNJT) appear to be the most efficacious oxygen therapy for preventing hypoxemia. |
• | The efficacy of different oxygen therapy methods in the prevention of hypoxemia was ranked as follows: NIPPV > WNJT > oropharynx/nasopharyngeal catheter > high-flow nasal oxygenation > nasal mask > nasal cannula. |
• | Clinicians should make a choice regarding the most suitable oxygen therapy based on the risk population, type of endoscopy and adverse events |
Keywords : Gastrointestinal endoscopy, Hypoxemia, Network meta-analysis, Propofol, Monitored anesthesia care
Abbreviations : AE, ASA, CI, ERCP, GI, GRADE, HFNO, NC, NM, NMA, NIPPV, ONPC, OR, PRISMA, AMSTAR, RCT, SpO2, SUCRA, WNJT
Plan
Vol 98
Article 111586- novembre 2024 Retour au numéro
Article précédent
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