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.
Study Type
OBSERVATIONAL
Enrollment
60
Medical Center Leeuwarden
Leeuwarden, Netherlands
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.
Time frame: at baseline, at 1,2,5 (15L),7 and 10 minutes (flush o2)
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.
Time frame: at baseline, at 1,2,5, (15L o2) and 7, 10 minutes (flush o2)
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.
Time frame: 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.
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Time frame: 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.
Time frame: 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
Time frame: at baseline, at 1,2,5 (15L o2) ,7 and 10 minutes (flush o2)