Implementing Preoxygenation in Obese Patients Prior to Esophagogastroduodenoscopy Procedures in a Fast-Paced Ambulatory Gastrointestinal Endoscopy Center: A Quality Improvement Project.

Obese patients undergoing esophagogastroduodenoscopy procedures require sedation ranging between deep sedation and general anesthesia to tolerate the procedure which predisposes this patient population to hypoxemia development. A practical, cost-effective, and readily available means of preoxygenation that can be implemented by certified registered nurse anesthetists practicing in high-volume, fast-paced ambulatory gastrointestinal endoscopy centers is the use of a nonrebreathing face mask with reservoir bag and one-way exhalation valve, along with oxygen flow rates at 15 liters per minute, and instructing the patient in taking eight vital capacity deep breaths over 60 seconds prior to start of the procedure. The purpose of this quality improvement project was to reduce intraprocedural hypoxemic events, defined as intraprocedural SpO2 values ≤ 90%, in obese patients undergoing esophagogastroduodenoscopy procedures with deep sedation using propofol. At baseline, 30.8% obese patients undergoing esophagogastroduodenoscopy procedures experienced hypoxemic events. Following preoxygenation, hypoxemic events were reduced to 14.3% with chi-square analysis showing statistical significance (χ2 = 8.859, P =.003). Preoxygenation of obese patients prior to esophagogastroduodenoscopy procedures is an evidence-based practice that can reduce hypoxemic event occurrence during the procedure and improve patient safety.