Journal of Clinical Anesthesiology: Open Access

Background: This study evaluated Integrated Pulmonary Index (IPI), a clinically validated algorithm combining PetCO₂, RR, SpO₂, and PR into a single value summarizing the adequacy of ventilation and oxygenation. ASA practice guidelines recommend continuous monitoring of these parameters during procedural sedation for early detection of respiratory compromise. Interpretation is routinely done by anesthesiologists but is challenging for other clinicians. IPI simplifies this process.

Methods: This was a two-phase observational evaluation of procedural sedation patients monitored with PetCO₂, RR, SpO₂ and PR (Capnostream20, Medtronic, Israel). In the first phase, IPI values were visible; in the second, the clinician was blinded to IPI. Clinician IPI evaluations were compared to algorithm-generated IPI.

Results: Good correlation and agreement between expert evaluation and actual IPI scores was found at both phases (ρ=0.98 for the first and 0.84 for the second, p-value for both <0.001; bias and standard were 0.04 ± 0.52 for the first and -0.01 ± 1.23 for the second).

Conclusion: IPI reliably interpreted respiratory status of patients undergoing procedural sedation or anesthesia in a clinical setting when compared to expert anesthesiologist evaluation and may simplify respiratory monitoring. Trial registration: Not provided, was not required at time of enrollment (2010)