Importance of Integrated Pulmonary Index in Pediatric Endoscopy
Condition: Monitored Anesthesia Care; Respiratory Monitoring
Study type: Interventional

Summary: 
      Integrated Pulmonary Index (IPI) is a tool that provides numerical values on a scale of 1-10
      based on physiological parameters such as peripheral oxygen saturation (SpO2), pulse rate,
      respiratory rate, end-tidal carbon dioxide (ETCO2). It is a valuable monitor for sedation
      procedures and can provide early warning during cardiorespiratory derangements. In this
      study, we wanted to evaluate the value of IPI in cases of pediatric endoscopy performed under
      sedation. Our outcome measure will be the correlation of IPI values with standard monitoring
      parameters.
    

Detailed description: 
      Upper gastrointestinal system (GIS) endoscopy is a common diagnostic or interventional
      procedure in cases such as foreign body ingestion, gastritis, peptic ulcer, esophagitis,
      esophageal variceal bleeding. Lower GIS endoscopy is a procedure performed in cases such as
      Crohn's or Ulcerative Colitis diseases, colon polyps, diverticular disease. It is routinely
      performed under general anesthesia or sedation in pediatric cases. In our clinic, we
      routinely perform diagnostic or interventional pediatric upper and lower endoscopy procedures
      with the non-operating room anesthesia team under monitored anesthetic care (MAC). Routine
      monitoring of MAC consists of electrocardiography (ECG), non-invasive blood pressure (NIBP),
      and peripheral oxygen saturation (SpO2). These monitorizations are described as minimum in
      many practice guidelines, and sometimes monitors such as end-tidal carbon dioxide (ETCO2),
      body temperature, analgesia/nociception index (ANI) can be added to them.

      The Integrated Pulmonary Index (IPI) is a tool that provides numerical values on a scale of
      1-10 based on physiological parameters such as peripheral oxygen saturation (SpO2), pulse
      rate, respiratory rate, end-tidal carbon dioxide (ETCO2).(1,2) When these parameters exceed
      physiological limits, patients require interventions consisting of various maneuvers or drug
      administration in order to maintain the normal functioning of the cardiorespiratory system.
      If we look at the scoring, a score of 8-10 is considered normal, a score of 5-7 indicates a
      situation that may require intervention, and a score of 1-4 indicates that the patient needs
      intervention.

      The above-mentioned IPI is a relatively new tool, and there is limited data in the literature
      regarding its usability in patients undergoing interventional procedures under MAC.(3,4) In
      this study, we wanted to evaluate the safety of IPI in cases of pediatric endoscopy performed
      under sedation. Routine monitoring and drug applications for the procedure will be in
      accordance with the institutional protocols, and additional IPI monitoring will be performed.
      Our outcome measure will be the correlation of IPI values with standard monitoring
      parameters.
    

Intervention name(s): Integrated Pulmonary Index (IPI) monitoring; propofol; ketamine
Intervention type(s): Device; Drug; Drug
Intervention description(s): Integrated Pulmonary Index (IPI) monitor will be applied to the patients, to provide numerical data obtained from the measurements of end-tidal carbon dioxide, respiratory rate, oxygen saturation measured by pulse oximetry (SpO2), and pulse rate.; propofol; ketamine
Intervention MeSH terms: Ketamine; Propofol
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Diagnostic