Use of Non-Invasive Positive Pressure Ventilation in Patients With Severe Obesity Undergoing Upper Endoscopy Procedures
Condition: Severe Obesity; Hypoxia
MeSH terms: Obesity; Obesity, Morbid; Hypoxia
Study type: Interventional

Summary: 
      The study evaluated the effect of non-invasive positive pressure ventilation (NIPPV) to
      decrease the incidence of desaturation events in patients with severe obesity undergoing
      upper endoscopy.
    

Detailed description: 
      Patients being evaluated for bariatric surgery often undergo preoperative upper endoscopy.
      Patients with obesity are at increased risk for sedation related adverse events during
      endoscopy. The study evaluated the effect of non-invasive positive pressure ventilation
      (NIPPV) to decrease the incidence of desaturation in patients with severe obesity undergoing
      upper endoscopy. The study was a randomized controlled trial that assessed the effectiveness
      of NIPPV in patients undergoing upper endoscopy. Patients were randomized into experimental
      group NIPPV or control group. Primary endpoints were desaturation events (SpO2 <=94%) and
      desaturation events requiring intervention (SpO2<=90%). A secondary endpoint was the use of
      NIPPV to rescue patients who developed a clinically significant desaturation event.
    

Intervention name(s): Non-invasive positive pressure ventilation through nasal mask; Rescue non-invasive positive pressure ventilation through nasal mask; Secondary rescue maneuvers
Intervention type(s): Device; Device; Other
Intervention description(s): Inspiratory pressure 12 cm H2O/Expiratory pressure 6 cm H2O which can be increased to meet a tidal volume (TV) of 300-800 mL (target is 450-500), with maximum Inspiratory pressure 18 cm H2O /Expiratory pressure 8 cm H2O on 100% FiO2.If TVs are more or less than 300 to 800 mL range, the pressure will be adjusted by 1-2 cm H2O) accordingly; If desaturation below 90 %, nasal cannula removed and non invasive positive pressure nasal mask connected to machine: Inspiratory pressure 12 cm H2O/Expiratory pressure 6 cm H2O which can be increased to meet a tidal volume (TV) of 300-800 mL (target is 450-500), with maximum Inspiratory pressure 18 cm H2O /Expiratory pressure 8 cm H2O on 100% FiO2.If TVs are more or less than 300 to 800 mL range, the pressure will be adjusted by 1-2 cm H2O) accordingly; If rescue non invasive positive pressure maneuver attempted (including adjustments in pressure) and O2 sat is not above 90 % within 3 min of starting non invasive positive pressure, scope removed and secondary rescue maneuver started. Secondary rescue maneuvers performed at the discretion of the anesthesiologist (chin lift, oral airway, bag mask, nasal trumpet, LMA, intubation). If sat > 90 % with secondary rescue maneuvers, resumption of scope exam to the discretion of anesthesia. If sat does not increase > 90 % with secondary rescue maneuvers, scope exam to be cancelled and patient care per anesthesiologist
Allocation: Randomized
Intervention model: Sequential Assignment
Intervention model description: Randomized controlled trial
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Supportive Care
Keywords: severe obesity; non-invasive positive pressure ventilation; endoscopy; hypoxia; bariatric surgery; sedation; adverse events; BMI; anesthesia; complications