Comparisons of the efficiency of respiratory rate monitoring devices and acoustic respiratory sound during endoscopic submucosal dissection

Abstract

During moderate sedation for gastrointestinal endoscopic submucosal dissection (ESD), monitoring of ventilatory function is recommended. We compared the following techniques of respiratory rate (RR) measurement with respiratory sound (RRa): capnography (RRc), thoracic impedance (RRi), and plethysmograph (RRp). This study enrolled patients aged ≥ 20 years who underwent esophageal (n = 19) and colorectal (n = 5) ESDs. RRc, RRi, RRp, and RRa were measured by Capnostream™ 20P, BSM-2300, Nellcor™ PM1000N, and Radical-7®, respectively. In total, 413 RR data were collected from the esophageal ESD group and 114 RR data were collected from the colorectal ESD group. Compared with RRa during colorectal ESD, that during esophageal ESD had larger bias [95% limit of agreement (LOA)] with RRc [1.9 (− 11.0–14.8) vs. − 0.4 (− 2.9–2.2)], RRi [9.4 (− 16.8–9.4) vs. − 1.5 (− 12.0–8.9)], and RRp [0.3 (− 5.7–6.4) vs. 0.2 (− 3.2–3.6)]. Of the correct RR values displayed during esophageal ESD, > 90% were measured as RRa and RRp. Moreover, RRc was a useful parameter during colorectal ESD. To maximize patient safety during ESD under sedation, endoscopists and medical staff should know the feature and principle of the devices used for RR measurement. During esophageal ESD, RRa and RRp may be a good parameter to detect bradypnea or apnea. RRc, RRa and RRp are useful for reliable during colorectal ESD.
Trial registration UMIN-CTR (UMIN000025421).

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Journal of Clinical Monitoring and Computing (2022) 36:1013–1019
https://doi.org/10.1007/s10877-021-00727-8
ORIGINAL RESEARCH
Comparisons oftheefficiency ofrespiratory rate monitoring devices
andacoustic respiratory sound duringendoscopic submucosal
dissection
TomokoFukada1 · YuriTsuchiya1· HirokoIwakiri1· MakotoOzaki1· MinoruNomura1
Received: 4 March 2021 / Accepted: 4 June 2021 / Published online: 12 June 2021
© The Author(s), under exclusive licence to Springer Nature B.V. 2021
Abstract
During moderate sedation for gastrointestinal endoscopic submucosal dissection (ESD), monitoring of ventilatory function is
recommended. We compared the following techniques of respiratory rate (RR) measurement with respiratory sound (RRa):
capnography (RRc), thoracic impedance (RRi), and plethysmograph (RRp). This study enrolled patients aged ≥ 20years who
underwent esophageal (n = 19) and colorectal (n = 5) ESDs. RRc, RRi, RRp, and RRa were measured by Capnostream™
20P, BSM-2300, Nellcor™ PM1000N, and Radical-7®, respectively. In total, 413 RR data were collected from the esopha-
geal ESD group and 114 RR data were collected from the colorectal ESD group. Compared with RRa during colorectal
ESD, that during esophageal ESD had larger bias [95% limit of agreement (LOA)] with RRc [1.9 (− 11.0–14.8) vs. − 0.4
(− 2.9–2.2)], RRi [9.4 (− 16.8–9.4) vs. − 1.5 (− 12.0–8.9)], and RRp [0.3 (− 5.7–6.4) vs. 0.2 (− 3.2–3.6)]. Of the correct RR
values displayed during esophageal ESD, > 90% were measured as RRa and RRp. Moreover, RRc was a useful parameter
during colorectal ESD. To maximize patient safety during ESD under sedation, endoscopists and medical staff should know
the feature and principle of the devices used for RR measurement. During esophageal ESD, RRa and RRp may be a good
parameter to detect bradypnea or apnea. RRc, RRa and RRp are useful for reliable during colorectal ESD.
Trial registration UMIN-CTR (UMIN000025421).
Keywords Endoscopic submucosal dissection· Respiratory rate· Capnography· Thoracic impedance· Plethysmograph·
Acoustic respiratory sound
1 Introduction
Gastrointestinal endoscopic submucosal dissection (ESD)
is usually performed under moderate sedation, using seda-
tives alone or in combination with analgesics or, sometimes,
using anesthetics such as propofol. Administration of these
drugs during ESD may sometimes induce deep sedation and
respiratory depression. The 2018 guidelines on moderate
procedural sedation and analgesia recommend continuous
capnometry monitoring of ventilatory function in addi-
tion to the standard monitoring by observation and pulse
oximetry unless precluded by the procedure or equipment
[1]. Pulse oximetry monitors oxygenation not ventilation,
whereas capnography detects hypoventilation before the
changes in pulse oximetry or respiratory rate (RR) under
oxygen supplement [2]. Therefore, capnography is the gold
standard of monitoring ventilatory function. However, RR
measured by capnography during upper gastrointestinal ESD
may be inaccurate because of the influence of insufflated
carbon oxide (CO2), which distends the intestinal lumen to
ensure adequate visibility and to secure the space required
for a safe procedure. On the other hand, RR measurement
by Radical-7®, which uses respiratory sound was reported
to be useful [3, 4]. Recently, various parameters are being
used to monitor RR at the operating room. The purpose of
this study was to determine and compare the utility of dif-
ferent RR monitoring devices during gastrointestinal ESD.
RR measured by Radical-7® (Masimo Japan Corp.,
Tokyo, Japan) with the use of acoustic respiratory sound
(RRa) was compared with RRs measured by capnography
(RRc) using Capnostream™ 20P (Medtronic Japan Co.,
* Tomoko Fukada
fukada.tomoko@twmu.ac.jp
1 Department ofAnesthesiology, School ofMedicine, Tokyo
Women’s Medical University, 8-1 Kawadacho Shinjukuku,
Tokyo162-8666, Japan
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