Capnography versus standard monitoring for emergency department procedural sedation and analgesia

Abstract

Use of capnography in emergency department patients being sedated for procedures Review questionWill carbon dioxide detection monitoring help reduce heart, lung, and airway complications for emergency department patients being sedated for painful procedures? BackgroundMedications are o en used in order to reduce pain or awareness (or both) for patients having painful procedures. Sometimes, complications involving a patient's heart, lungs, or airway (breathing tubes) can occur due to these medicines (e.g. vomit inhaled by the lungs). Healthcare workers monitor heart rate, blood pressure, breathing rate, and blood oxygen content to help prevent complications.Capnography (measuring carbon dioxide gas as a patient breathes out) use has been proposed to further increase the safety of sedating patients in the emergency department. This study was performed to determine if capnography makes a di erence when added to standard monitoring. Study characteristicsWe searched for studies using multiple research databases, conference research abstracts, and by contacting experts in the field. The evidence is current to August 2016. We only considered studies with participants being sedated for procedures in the emergency department. We only included studies that compared capnography and standard monitoring to standard monitoring only.The main outcomes involved events of low blood oxygen content, low blood pressure, and vomiting. We also recorded how many times the healthcare providers had to help the patient breathe easier. This could mean simple actions such as opening of the mouth to more serious manoeuvres such as mechanically breathing for the patient.Three studies with 1272 people, containing moderate evidence, were included in our study. Key resultsThere was no di erence in heart, lung, or airway complications with the addition of capnography. When only adults were studied, healthcare providers performed more manoeuvres to help the patient breathe when capnography was used. This could be due to false alarms. Quality of evidenceThe level of evidence was determined to be moderate. Capnography versus standard monitoring for emergency department procedural sedation and analgesia (Review)

Association between capnography and recovery time after procedural sedation and analgesia in the emergency department

“…This was concordant with the results of a recent systematic review and meta-analysis, which showed no differences in the rate of oxygen desaturation (risk ratio, 0.89; 95% CI, 0.48-1.63; n = 1272, three trials; moderate-quality evidence) and airway interventions (risk ratio, 1.26; 95% CI, 0.94-1.69; n = 1272, three trials; moderate-quality evidence). 11 In our study, hypoxemia and apnea occurred more frequently (i.e. hypoxemia, 10%; apnea, 6%) than in previous studies (hypoxemia, 4%; apnea, 1%).…”

“…rate of airway interventions in adults in the capnography group. 11 Recovery time was defined as the time from the end of the procedure to the cessation of monitoring. 12 Patients who receive PSA should be monitored until they are no longer at risk for respiratory depression and hemodynamic instability and they return to their baseline level of consciousness.…”

“…6 A systematic review and meta-analysis that examined the usefulness of capnography showed little evidence on the relationship between the use of capnography and recovery time. 11 We hypothesized that by using capnography, physicians may quickly assess and intervene in hypoventilation; therefore, appropriate sedation can contribute to shortening the recovery time. A longer recovery time could lead to longer length of stay in the ED and ED crowding, which is associated with mortality and a higher rate of individuals who leave without being seen in the ED.…”

Updated S3 Guideline “Sedation for Gastrointestinal Endoscopy” of the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) – June 2023 – AWMF-Register-No. 021/014

“…A Cochrane analysis evaluated the effect of capnography on the performance of painful procedures in an emergency unit (no endoscopic examinations). Three randomized controlled studies were found, but a reduction in complications could not be shown [418].…”

Aktualisierte S3-Leitlinie „Sedierung in der gastrointestinalen Endoskopie“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)

“…B. durch den MOAA/S-Score) gefordert [382,384] In drei neueren, internationalen Leitlinien wird der Einsatz der Kapnografie bei Hochrisikopatienten, tiefer Sedierung und langdauernden Prozeduren empfohlen ("recommended"), ohne dass eine eindeutige klare Empfehlung ausgesprochen wird [373,381,383]. In einer Cochrane-Analyse wurde der Effekt der Kapnografie bei der Durchführung schmerzhafter Prozeduren in einer Notfallambulanz (keine endoskopischen Untersuchungen) evaluiert, es wurden hier drei randomisierte kontrollierte Studien gefunden, eine Reduktion von Komplikationen konnte jedoch nicht gezeigt werden [418].…”