Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy.

BACKGROUND: Pulse oximetry is a widely accepted procedure for ventilatory monitoring during gastrointestinal endoscopy, but this method provides an indirect measurement of the respiratory function. In addition, detection of abnormal ventilatory activity can be delayed, especially if supplemental oxygen is provided. Capnography offers continuous real-time measurement of expiratory carbon dioxide. OBJECTIVE: We aimed at prospectively examining the advantages of capnography over the standard pulse oximetry monitoring during sedated colonoscopies. PATIENTS AND METHODS: Fifty patients undergoing colonoscopy were simultaneously monitored with pulse oximetry and capnography by using two different devices in each patient. Several sedation regimens were administered. Episodes of apnea or hypoventilation detected by capnography were compared with the occurrence of hypoxemia. RESULTS: Twenty-nine episodes of disordered respiration occurred in 16 patients (mean duration 54.4 seconds). Only 38% of apnea or hypoventilation episodes were detected by pulse oximetry. A mean delay of 38.6 seconds was observed in the events detected by pulse oximetry (two episodes of disturbed ventilation were simultaneously detected by capnography and pulse oximetry). CONCLUSIONS: Apnea or hypoventilation commonly occurs during colonoscopy with sedation. Capnography is more reliable than pulse oximetry in early detection of respiratory depression in this setting.

Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy

Background: pulse oximetry is a widely accepted procedurefor ventilatory monitoring during gastrointestinal endoscopy, butthis method provides an indirect measurement of the respiratoryfunction. In addition, detection of abnormal ventilatory activitycan be delayed, especially if supplemental oxygen is provided.Capnography offers continuous real-time measurement of expiratorycarbon dioxide.Objective: we aimed at prospectively examining the advantagesof capnography over the standard pulse oximetry monitoringduring sedated colonoscopies.Patients and methods: fifty patients undergoing colonoscopywere simultaneously monitored with pulse oximetry and capnographyby using two different devices in each patient. Several sedationregimens were administered. Episodes of apnea or hypoventilationdetected by capnography were compared with the occurrence ofhypoxemia.Results: twenty-nine episodes of disordered respiration occurredin 16 patients (mean duration 54.4 seconds). Only 38% ofapnea or hypoventilation episodes were detected by pulse oximetry.A mean delay of 38.6 seconds was observed in the events detectedby pulse oximetry (two episodes of disturbed ventilationwere simultaneously detected by capnography and pulse oximetry).Conclusions: apnea or hypoventilation commonly occursduring colonoscopy with sedation. Capnography is more reliablethan pulse oximetry in early detection of respiratory depression inthis setting(AU)

Assessing relationships between health-related quality of life and adherence to antiretroviral therapy.

OBJECTIVE: To investigate associations between health-related quality of life (HRQoL), as assessed using the multidimensional quality of life-HIV (MQOL-HIV) questionnaire, and adherence to antiretroviral treatment in HIV-infected subjects. DESIGN: Multicentre cross-sectional study in three institutional tertiary hospitals in northwest Spain. PATIENTS AND METHODS: The MQOL-HIV was completed by 235 HIV-infected adults undergoing antiretroviral treatment. Adherence to antiretroviral therapy was assessed by using patient's self-report. Information about sociodemographic characteristics and clinical variables was also collected. RESULTS: Good adherence (> or = 95% of prescribed pills correctly taken) was reported by 131 patients (55.7%). Univariate analyses indicated that the sociodemographic and clinical variables associated with adherence were age, educational level, income, employment, home stability, transmission route, history of previous antiretroviral therapy, and number of prescribed pills/day. Subscales of MQOL-HIV associated with adherence were mental health, cognitive functioning, financial status, medical care, partner intimacy, and (in men only) sexual functioning. Stepwise logistic regression showed that good adherence was more frequent in patients aged > 40 years (odds ratio, OR: 2.50; 95% confidence interval, CI: 1.15-5.61) and in patients with high cognitive functioning (OR: 2.26; 95% CI: 1.19-4.30). Conversely, poor adherence was more frequent in patients without stable home (OR: 2.96; 95% CI: 1.39-6.32), in patients required to take 14 or more pills/day (OR: 2.17; 95% CI: 1.18-4.28), in patients with low financial status (OR: 3.42; 95% CI: 1.57-7.45), and in patients reporting low medical care (OR: 2.07; 95% CI: 1.07-3.98). CONCLUSIONS: HRQoL dimensions, notably cognitive functioning, financial status and medical care, are closely associated with antiretroviral therapy adherence.