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An evaluation of the Integrated Pulmonary Index (IPI) for the detection of respiratory events in sedated patients undergoing colonoscopy

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Abstract

The Integrated Pulmonary Index (IPI™) is a new decision making tool calculated from measured end tidal carbon dioxide (etCO2), respiratory rate (RR), oxygen saturation (SpO2) and pulse rate (PR) using a fuzzy logic model. The aim of this study was to compare prospectively IPI to respiratory adverse events in patients undergoing moderate sedation for colonoscopy. Following ethics committee approval and personal informed consent 51 adult patients undergoing elective colonoscopy were enrolled. Patients received routine care by the endoscopy staff that were blinded to IPI, etCO2, and RR; whilst a trained senior anesthesiologist observer, not involved in the procedure, collected this data. ‘Requires attention’ respiratory adverse events (at least 1 min of SpO2 ≤ 92 % and/or RR ≤ 8 and or 20 % decrease in etCO2) and ‘requires intervention’ respiratory adverse events (at least 1 min of SpO2 ≤ 85 % and/or RR = 0) were documented by the observer. There were no differences in etCO2, RR, SpO2 and PR between 5778 IPI readings ranging from 1 to 10. Low (1–3), medium (4–6) and high (7–10) IPI groups did not differ in RR, SpO2 and PR, but etCO2 was higher in the high IPI group (p = 0.0185). Among requires attention events (n = 113) the IPI was high (7–10) in 53.1 %, intermediate (4–6) in 32.7 %, or low (1–3) in 14.2 %. The presented data demonstrate limited agreement between respiratory physiological parameters and the IPI. Further IPI evaluation and validation is indicated mainly for events requiring immediate intervention and in different patient populations including obese patients.

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Acknowledgments

To Prof. Bar-Meir the former chair of the gastroenterology department for his support of this research.

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Authors and Affiliations

  1. Department of Anesthesiology and Intensive Care, Sheba Medical Center, Tel Hashomer, Israel

    Haim Berkenstadt, Erez Ben-Menachem & Rina Dach

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Haim Berkenstadt

  3. Department of Orthopedics, Talpiot Medical Leadership Program, Sheba Medical Center, Tel Hashomer, Israel

    Amir Herman

Authors
  1. Haim Berkenstadt
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  2. Erez Ben-Menachem
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  3. Amir Herman
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  4. Rina Dach
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Correspondence to Haim Berkenstadt.

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Berkenstadt, H., Ben-Menachem, E., Herman, A. et al. An evaluation of the Integrated Pulmonary Index (IPI) for the detection of respiratory events in sedated patients undergoing colonoscopy. J Clin Monit Comput 26, 177–181 (2012). https://doi.org/10.1007/s10877-012-9357-x

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  • DOI: https://doi.org/10.1007/s10877-012-9357-x

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