Efficact of Supplemental Oxygen During Procedural Sedation and Analgesia in Elderly Patients in the Emergency Department

Kentaro Fukano; Yosuke Homma; Tatsuya Norii; Japanese Procedural Sedation and Analgesia Registry Investigators

doi:10.1016/j.jemermed.2023.05.004

Efficact of Supplemental Oxygen During Procedural Sedation and Analgesia in Elderly Patients in the Emergency Department

J Emerg Med. 2023 Oct;65(4):e310-e319. doi: 10.1016/j.jemermed.2023.05.004. Epub 2023 Jun 4.

Authors

Kentaro Fukano¹, Yosuke Homma², Tatsuya Norii³; Japanese Procedural Sedation and Analgesia Registry Investigators

Affiliations

¹ Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama-shi, Saitama-ken, Japan.
² Department of Emergency Medicine, Chiba Kaihin Municipal Hospital, Chiba-city, Chiba, Japan.
³ Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico.

PMID: 37704505
DOI: 10.1016/j.jemermed.2023.05.004

Abstract

Background: The use of supplemental oxygen (SO) for procedural sedation and analgesia (PSA) is recommended in many guidelines, but the evidence of SO for the elderly is limited.

Objectives: This study aimed to compare the incidence of hypoxia with or without SO in PSA for the elderly patients.

Methods: We prospectively collected data on all patients undergoing PSA in the emergency department (ED) from May 2017 through December 2021. These data are from the Japanese Procedural SedaTion and Analgesia Registry. We included all elderly patients (65 years and older) who received PSA in the ED. We performed propensity score analysis for inverse probability of treatment weighting (IPTW) to balance the baseline characteristics. The primary outcome was the incidence of hypoxia (SpO₂ < 90%), and the secondary outcome was the incidence of bag-valve mask ventilation.

Results: Among 1465 patients in the registry, we included 816 (55.7%) patients in the analysis. After propensity score method for IPTW, the distributions of confounders were closely balanced between the two groups. The incidence of hypoxia was significantly lower in the SO group compared with the non-SO group (6.2% vs. 19.3%; difference -13.1%; 95% confidence interval [CI] -9.8 to -16.4; p < 0.001). SO was also associated with a lower incidence of bag-valve mask ventilation (5.2% vs. 15.4%; difference -10.2%; 95% CI -7.1 to -13.2; p < 0.001).

Conclusions: In a propensity-matched analysis, SO was associated with a lower incidence of hypoxia in elderly patients during ED PSA.

Keywords: elderly; emergency department; procedural sedation; propensity score; supplemental oxygen.