Bilevel positive airway pressure ventilation in patients susceptible to hypoxemia during procedural sedation for colonoscopy: A prospective randomized controlled study

Background and aims Hypoxemia is one of the most common adverse events during colonoscopy, particularly among patients who are diagnosed with obstructive sleep apnea (OSA) or are overweight. Consequently, the objective of this study is to evaluate the effectiveness of bilevel positive airway pressure (BPAP) ventilation for patients with high risk hypoxemia during colonoscopy with sedation. Methods In this trial, 127 patients who met the eligibility criteria were randomly assigned to the BPAP oxygen and nasal cannula (NC) group. The primary endpoint was the incidence of hypoxemia. Results Compared to the use of NC, BPAP ventilation exhibited a significant reduction in the incidence of hypoxemia, decreasing it from 23.8% to 6.3% (absolute risk difference [ARD]: 17.5% [95% confidence interval (CI), 5.4 to 29.6], p = 0.006). Importantly, BPAP ventilation prevented the occurrence of severe hypoxemia (9.5% vs. 0%, ARD: 9.5% [95% CI, 2.3 to 16.7], p = 0.035). Besides, the BPAP group required fewer airway interventions (p < 0.05). Conclusions In individuals with OSA or overweight status, the use of BPAP ventilation during colonoscopy significantly reduced the incidence of hypoxemia.