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October 18, 2009
9:00 AM - 11:00 AM
Room Area F
The Integrated Pulmonary Index: Validity, Safety and Application in the Pediatric Population
  *  David Gozal, M.D., Yaacov Gozal, M.D.
Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Jerusalem, Israel

In the field of pediatric anesthesia/sedation, the time to reaction to a respiratory event leading to a decrease in the oxygen saturation (SpO2) is critical.The Integrated Pulmonary Index™ (IPI), (Oridion,Israel) was developed in order to provide non-anesthesiologists with a tool that would enable them to follow the respiratory status of a monitored patient and assist them in determining whether intervention is required. It is a representation of 4 parameters: EtCO2, RR, SpO2 and PR, in the form of a single index value ranging from 1 to 10 with trend information.The aim of the study was to evaluate the validity and safety of the Index and its application during procedural pediatric sedation.


After IRB approval and written consent from parents, electronic monitor recordings of 77 consented children were analysed. All the patients underwent a procedure requiring deep sedation.We used a FDA-cleared Capnostream 20 (Oridion,Israel) hooked to a PC computer with dedicated software and screen display. It resulted in a calculated IPI that was evaluated by a senior anesthesiologist and compared to the respiratory status of the child. In a second part of the study, the IPI was blinded to the practitioner, and was evaluated by him. Clinically significant events were defined as: central or obstructive apnea, hypoventilation with hypoxia, hypoxia, hypocapnia or hypercapnia.


76 out of 77 children met the inclusion criteria. Only 1 child had a failed sedation and was excluded from the study. Their mean age was 4.8 years. They were connected to the monitor for at least 30 minutes.They breathed spontaneously and got oxygen through a nasal cannula that measured EtCO2 and RR (Smart Capnoline H Plus O2, Oridion, Israel). For all events, the IPI value shown by the software was 6 or less.The sensitivity for each of the events was 1.0, indicating that all prospectively defined clinically significant events were detected appropriately by the IPI. The resulting specificity was 0.98, indicating a high level of effectiveness. 90% of the alarms generated by the monitor were true-positive alarms. There was a good correlation between the true IPI and the evaluated one (in the blind part of the study)(80 % Δ IPI = 0.1)


The IPI has been shown to correlate well with the respiratory status of pediatric patients for procedures under deep sedation. The IPI is displayed as a numeric value in a simple and clear manner that would be particularly useful for non-expert personnel monitoring patients undergoing procedures requiring sedation. In these cases the availability of a simple tool informing the practitioner of the patient's respiratory status that may promote early awareness to critical changes is particularly valuable.

From Proceedings of the 2009 Annual Meeting of the American Society Anesthesiologists.