DOI

10.21007/con.dnp.2024.0089

Faculty Advisor

Dwayne Accardo, DNP, CRNA, FAANA and Tracy McClinton, DNP, AG-ACNP-BC, APRN

Document Type

Poster

Publication Date

Spring 4-26-2024

Disciplines

Health and Medical Administration | Investigative Techniques | Medicine and Health Sciences | Nursing | Nursing Administration | Perioperative, Operating Room and Surgical Nursing | Quality Improvement | Surgery

Abstract

Purpose/Background

Hypoxia is a severe adverse event that is often associated with sedated endoscopy procedures, and bariatric patients have a significantly higher risk for complications related to oxygenation during sedation due to pathophysiological changes to the respiratory system. This scoping review compares the rate of hypoxemic events with the use of a binasal cannula versus a procedural oxygen mask during inpatient endoscopic procedures in patients aged 19-64 with a BMI greater than 40.

Methods

The scoping review includes control trials with and without randomization, case-control/cohort studies, systematic reviews, and qualitative/descriptive studies. With limited research regarding the PICOT, extending the age of qualifying articles beyond the desired five years was necessary. This scoping review focuses on utilizing the POM mask to prevent hypoxia during upper endoscopies and some alternative approaches. Databases utilized for this review include EBSCO, CINAHL, Pubmed, and Medline. The literature search initially resulted in 10,525 articles, which then were narrowed down to 10 based on their pertinence to the PICOT question.

Results

Many outcomes were reported, the most commonly being hypoxemic events with a BMI >30 without preoxygenation, hypoxemic events with a BMI >30 with preoxygenation, hypoxia with a bi-nasal cannula, and procedural termination with preoxygenation. Data from randomized control trials and case-control studies showed a decrease in both hypoxemic events and early termination of the procedure with adequate preoxygenation. Four reports of decreased instances of hypoxemia were reported with the bi-nasal cannula; however, there were also four reports of increased instances, leaving mixed results.

Implications for nursing practice

A summary of the evidence supports using the procedural oxygen mask in the bariatric population undergoing endoscopy procedures. Current research indicates that the POM should be the new standard of care due to this population's dramatic decrease in hypoxemic events. Anesthesia providers should stay updated on the standard of care and best practices related to bariatric endoscopies.

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