Cardiac Output, Low, Hyperoxia
Conditions
Keywords
Procedural sedation, Cardiac output measurements non-invasive, Emergency department
Brief summary
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.
Detailed description
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.
Interventions
None listed
Sponsors
Frisius Medisch Centrum
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients presenting in the ED of the Medical Center Leeuwarden (MCL) who have a painful condition for which procedural sedation is required.
Exclusion criteria
* \- Cardiogenic shock (SBP\<90 mmHg) * Procedural sedation for cardioversion * Pregnancy * General contra-indications for the procedural sedation according to local sedation protocol of the MCL. * Hypoxia (sat \<90% or pO2 \<8)) despite oxygen suppletion * Age \< 18 years * Non-invasive ventilation (NIV) or intubation * No informed consent * Use of bleomycin * COPD GOLD III of IV * COPD GOLD I of II with hypercapnia (PCO2 \> 6,4 kPa) * Patients in whom no reliable signal for Clearsight measurement can be obtained
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The change in cardiac output (L/min) after respectively 15L/min and flush rate preoxygenation in respect to baseline | at baseline, at 1,2,5 (15L),7 and 10 minutes (flush o2) | 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. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The change in heart rate (BPM) after respectively 15L/min and flush rate preoxygenation in respect to baseline | at baseline, at 1,2,5, (15L o2) and 7, 10 minutes (flush o2) | 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. |
| the change in systolic blood pressure (mmHg) after respectively 15L/min and flush rate preoxygenation in respect to baseline | at baseline, at 1,2,5 (15L o2) and 7, 10 minutes (flush o2) | 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. |
| The change in stroke volume (ml) after respectively 15L/min and flush rate preoxygenation in respect to baseline | at baseline, at 1,2,5 (15L o2) and 7, 10 minutes (flush o2) | 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. |
| the change in total peripheral vascular resistance after respectively 15L/min and flush rate preoxygenation in respect to baseline | at baseline, at 1,2,5 (15L o2) and 7,10 minutes (flush o2) | 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. |
| The relation of the difference in CI with the occurrence of of haemodynamic sedation events | at baseline, at 1,2,5 (15L o2) ,7 and 10 minutes (flush o2) | 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 |
Countries
Netherlands
Outcome results
None listed