TSE "Mask"

Research
We have several on-going research projects and our preliminary data showed
that TSE "Mask" improves oxygenation and prevents severe desaturation in
sedated patients during upper GI endoscopic procedures, TEE and
cardioversion/AICD. We continue to study the effectiveness of the simple face
tent  in improving oxygenation and patient safety during sedation, MAC and
TIVA.
We welcome any collaboration with investigators at other institutes.
  Control
(n=73)
TSE "Mask"
(n=74)
Age yrs
58±16
61±15
BMI
26.7±6
28.7±9
Duration (min)
38±24
31±21
Propofol
(ug/kg/min)
280±189
250±126
Median of highest
O2 flow (l/min)
10, 4-10
6, 4-10*
Mean of lowest O2
Sat
88±11%
93±7%*
Severe Desat
(O2 Sat
85%)
19/73
6/74*
Assisted
Ventilation with
Ambu bag
16/73
2/74*
A.  A Prospective Study - The Effects of TSE "Mask" on O2 Saturation in Sedated Patients during
    Upper GI  Endoscopy

Methods:  Our Institutional Review Board approved this study. Patients (American Society of Anesthesiologists
Physical Status I or II) were consented and assigned randomly to the Control Nasal Cannula group or TSE
“Mask” group using an Excel–Random-Generator. Monitors included ECG, BP cuff, pulse oximetry and
capnography. Patients received O2 via nasal cannula (4 and up to 10 liter/min as needed) in the absence
(Control Nasal Cannula, n=73) or presence (TSE “Mask” group, n=74) of a TSE “Mask” which is a face tent
made out of a clean specimen bag. Patients received intravenous propofol that was titrated to achieve deep
sedation. Data collected included the age, the weight (Wt), the height (Ht), the length of the procedure and the
total amount of propofol administered, the highest O2 flow, the lowest O2 saturation, the need for assisted
ventilation using Ambu bag. Body Mass Index (Wt in kg/ Ht in cm) the average propofol dose
(microgram/kg/min) were calculated for comparison. SAS is used for statistical analysis.  A p value < 0.05 is
considered as statistically significant (*). The data are presented as Mean±S.D.

Results:  There is no significant difference between two groups in the age, the BMI, the procedure duration or
the average propofol dose. There is a significant difference in the median of the highest O2 flow, the lowest O2
saturation, severe O2 desaturation (≤ 85%) and the need for assisted ventilation using Ambu bag. TSE “Mask”
significantly reduces severe O2 desaturation (≤ 85%) by 3-folds and the need for assisted ventilation by 8-folds.


















Conclusions:  These data suggest that TSE “Mask” reduces severe oxygen desaturation and the need for assisted
ventilation in deeply sedated patients during upper GI endoscopy. This face tent utilizes a plastic bag that is
ubiquitous at no additional cost and should be used routinely during upper endoscopic procedures.  

B.  Retrospective Studies

1. The Effects of TSE "Mask" on Oxygenation in High-Risk Patients during Transesophageal
Echocardiography in a Retrospective Study

Methods:  This is a retrospective review of nursing records at Echo Lab (9/071/08). Patients received topical
anaesthesia (15 cc viscous lidocaine and benzocaine spray x 3) and NC O2 (5 l/min). Midazolam (0.5-4 mg)
and/or meperidine (12.5-50 mg) were titrated by cardiologists to achieve adequate sedation prior to inserting a
TEE probe. A TSE Mask was prepared using a clean clear specimen bag to cover patients nose and mouth.
Three groups (G) of patients were identified. G1 (n=81) received only NC O2 throughout the case. G2 (n=20)
initially received NC O2, developed desaturation with sedation and a TSE Mask was then applied to the patient.
G3 (n=24) received NC O2 with a TSE Mask throughout the case. The paired and unpaired Students t-tests were
used for analysis. A p value <0.05 is considered as significant. Data are presented as Mean±S.D.

Results: There were no differences among groups in doses (ug/kg) of midazolam (G1:32±17; G2:25±7; G3:
26±14) and meperidine (G1:325±293; G2:306±234; G3:235±245). G1 had a baseline RA O2 Sat of 97±2% that
was increased to 99±1% and maintained at 99±1% with NC O2. G2 had a lower RA O2 Sat (95±3%) than G1. It
was increased to 97±2% with NC O2 . However, G2 patients experienced significant O2 desaturation (93±3%)
with sedation. It was significantly improved and maintained (98±2%) with a TSE Mask for the rest of the case.
G3 had a significantly lower RA O2 Sat (92±4%) than those of G1 and G2. It was increased to 96±3% by NC O2.
Their oxygenation was further significantly improved (98±2%) and maintained throughout sedation and the
procedure (98±2%) with a TSE Mask.

Conclusion: These data show that a TSE Mask improves oxygenation and prevents O2 desaturation in sedated
high-risk patients during TEE at no cost. This simple face tent may improve patient safety and should be
routinely used during TEE.


2. The Effects of TSE "Mask" on Oxygenation in Sedated Patients during Upper GI Endoscopy.

Methods: This is a retrospective review of records of patients undergoing EGD, EUS, ERCP or PEG (9/08-11/08).
Standard monitors included ECG, BP cuff, pulse oximetry and capnography with/without O2 sensor. All
patients received NC O2 (3-5 l/min, or higher as needed). Group 1 patients (NC, n=31) received only NC O2.
Group 2 patients (TM, n=25) received NC O2 and a TSE "Mask". A TSE "Mask" was prepared using a clean
plastic specimen bag (n=17) or a plastic fluid-shield surgical mask (n=8). It covered the patient's eyes, nose and
mouth. Patients received iv propofol titrated to achieve satisfactory sedation prior to endoscopic probe
insertion. Data collected included age, weight, height, the room air (RA) O2 saturation (O2 Sat), O2 Sat at 5
min intervals, the need for assisted ventilation with an Ambu bag, the amount of propofol, the procedure
duration and inspiratory/expiratory O2 concentrations via nasal cannulae (in the TM patients receiving a
plastic shield). Student’s t-test and Chi Square test were used for statistical analysis. A p value <0.05 is
considered as significant (Mean±S.D.) .

Results: There were no differences in age (yrs) (NC: 62±16; TM: 59±20), BMI (NC: 24.4±4.2; TM: 25.8±6.5),
ASA physical classification, RA O2 Sat (NC: 99±2%: TM: 98±3%), the duration (min) (NC: 29±14; TM: 29±20),
the dosages of propofol (ug/kg/min) (NC: 199±71; TM: 220±112), severe O2 desaturation (O2 Sat ≤ 85%) (NC:
3/31; TM: 0/25) and the need for assisted ventilation (NC: 1/31; TM: 0/25) between groups. There were
significant differences in the highest O2 flow (l/min) (NC: 4±2; TM: 5±1), O2 Sat after 5 min with supplemental
O2 (NC: 99±3; TM: 100±1%) and the lowest O2 Sat (NC: 93±9%; TM: 98±3%) between groups. Propofol sedation
significantly decreased O2 Sat in both groups (NC: 99±3 to 93±9%; TM: 100±1% to 98±3%) (Table 1). With air
samples obtained through a nasal cannula, the FeO2 (73±14%) was significantly higher than FiO2 (34±10%) in
TM patients who received a plastic shield.

Discussion: Data show that TSE "Mask" improves oxygenation and reduces the risk of desaturation in sedated
patients by increasing O2 delivery. This simple face tent may improve patient safety at no or minimal cost and
should be routinely used during upper endoscopy.


3. The Effects of TSE "Mask" on Oxygenation in High-Risk Patients during Cardioversion/AICD.

Methods: This is a retrospective review of Cath Lab procedures of 89 patients (ASAIII) undergoing
cardioversion or testing of AICD (5/08-9/08). Standard monitors included ECG, BP cuff, pulse oximetry with
or without arterial BP. Patients received NC O2 (3-5 l/min or higher as needed). Group 1 (NC) patients received
only NC O2 throughout the procedure and Group 2 (TM) received routine NC O2 and a TSE "Mask". A TSE
"Mask" was prepared using a clean clear plastic bag and used to cover patient's nose and mouth. Patients
received iv propofol that was titrated to achieve deep sedation prior to induction of ventricular
tachycardia/fibrillation and/or cardioversion. Data collected for comparison included age, weight, height, the
baseline room air (RA) O2 saturation (O2 Sat), O2 Sat with Suppl O2 at 5 min intervals, the lowest O2 Sat,
assisted ventilation with Ambu bag and the amount of propofol received. The paired and unpaired Student’s t-
tests and Chi Square test were used for statistical analysis. A p value <0.05 is considered as statistically
significant. Data are presented as Mean±S.D.

Results: There were no differences in age (NC: 70±13; TM: 67±12 yrs), BMI (NC: 29±7; TM: 30±8), the baseline
RA O2 Sat (99±1%), O2 Sat after 5 min with Suppl O2 (99±1%) and the dosages of propofol (NC: 1.2±1.8; TM: 0.9
±0.3 mg/kg) between two groups. Propofol significantly reduced O2 Sat in both groups (NC: 99±1% to 86±11%;
TM: 99±1% to 94±7%). However, its effects were signifcantly greater on Group 1 than Group 2 patients. There
were significant differences in the lowest O2 Sat (NC: 86±11%; TM: 94±7%), severe O2 desaturation (≤ 85%)
(NC: 37%; TM: 9%) and the need for assisted ventilation with Ambu bag (NC: 35%; TM: 5%) between groups.

Discussion: These data show that TSE "Mask" reduces severe oxygen desaturation and the need for assisted
ventilation in deeply sedated high risk cardiac patients. This technically simple and effective face tent may
improve patient safety at no additional cost and should be routinely used during AICD/Cardioversion.

Please go to PUBLICATION for links for other Research Projects
  Publication
FOB  with a plastic shield from a fluid-shield surgical mask. Tape the sharp edges to avoid corneal abrasion.
MRI of the Head: Plastic sheet covering the cage to creat
an oxygen hood.     
Prone or Jack-knife position: Plastic sheet covering the head.