Capnography versus standard monitoring for emergency department procedural sedation and analgesia

Wall, Brian F; Magee, Kirk; Campbell, Samuel; Zed, Peter J.

doi:10.1002/14651858.cd010698.pub2

Cited by 16 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent guideline from the American Academy of Pediatrics recommends using an end-tidal carbon dioxide monitor during pediatric PSA ( 5 ). However, a systematic review showed no difference in cardiorespiratory adverse events between standard monitoring with and without capnography for emergency department procedural sedation ( 17 ). Virtual monitoring devices such as capnography were not mandated in this study.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

2020

View full text Add to dashboard Cite

Background: The volume of pediatric Procedural Sedation and Analgesia (PSA) outside the operating room has been increasing. This high clinical demand leads non-anesthesiologists, especially pediatric intensivists, pediatricians, and emergency physicians, to take a role in performing procedural sedation. Our department has established the PSA service by pediatric intensivists since 2015. Objectives: We aimed to assess the efficacy and safety of PSA outside the operating room conducted by pediatric intensivists and identify risk factors for severe adverse events. Methods: This was a retrospective descriptive study conducted from January 2015 to July 2019. Children aged less than 20 years who underwent procedural sedation were included. We collected demographic data, sedative and analgesic medications, American Society of Anesthesiologists (ASA) Physical Status Classification, indications for sedation, the success of procedural sedation, and any adverse events. Results: Altogether, 395 patients with 561 procedural sedation cases were included. The median age was 55 months (range: 15 to 119 months), and 58.5% (231/395) were male. The rate of successful procedures under PSA was 99.3%. Serious Adverse Events (SAE) occurred in 2.7%. Patients who received more than three sedative medications had higher SAE than patients who received fewer medications (adjusted for age, location of sedation, type of procedure, and ASA classification) (odds ratio: 8.043; 95% CI: 2.472 - 26.173, P = 0.001). Conclusions: Our data suggest that children who undergo procedural sedation outside the operating room conducted by pediatric intensivists are safe and effectively treated. Receiving more than three sedative medications is the independent risk factor associated with serious adverse events.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

2020

View full text Add to dashboard Cite

show abstract

“…In a recent meta-analysis, 23 there was a lack of convincing evidence that the addition of capnography to standard monitoring in emergency departments reduced the rate of adverse events including hypoxemia. However, most of the procedures included in that analysis were orthopedic manipulation, abscess incision and drainage, or cardioversion, which differ from elective procedures.…”

Section: Discussionmentioning

confidence: 99%

The addition of capnography to standard monitoring reduces hypoxemic events during gastrointestinal endoscopic sedation: a systematic review and meta-analysis

Kim

Park

Lee

et al. 2018

TCRM

View full text Add to dashboard Cite

BackgroundThe use of capnography monitoring devices has been shown to lower the rates of hypoxemia via early detection of respiratory depression, and facilitate more accurate titration of sedatives during procedures. The aim of the current meta-analysis was to compare the incidence of hypoxemia associated with standard monitoring alone during gastrointestinal endoscopy to that associated with standard monitoring with the addition of capnography.MethodsThe MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials scientific databases were searched to identify relevant studies. We performed a meta-analysis of randomized controlled trials undertaken up to January 2018 that met our predefined inclusion criteria. The study outcome measures were incidence of hypoxemia, severe hypoxemia, apnea, the use of assisted ventilation, the use of supplemental oxygen, and change in vital signs.ResultsWe included nine trials assessing a total of 3,088 patients who underwent gastrointestinal procedural sedation. Meta-analysis of study outcome revealed that capnography significantly reduced the incidence of hypoxemia (odds ratio 0.61, 95% CI 0.49–0.77) and severe hypoxemia (odds ratio 0.53, 95% CI 0.35–0.81). However, there were no significant differences in other outcomes including incidence of apnea, assisted ventilation, supplemental oxygen, and changes in vital signs. Early procedure termination and patient satisfaction-related outcomes did not differ significantly in the capnography group and the standard monitoring group.ConclusionThis study indicates that capnography monitoring is an important addition with regard to the detection of hypoxemia during gastrointestinal procedural sedation, and should be considered in routine monitoring during gastrointestinal endoscopy.

show abstract

“…Evidence for the effectiveness of continuous electronic monitoring using capnography indicates improved patient safety outcomes when using opioids (Carlisle, 2015;McCarter, Shaik, Scarfo, & Thompson, 2008;Overdyk et al, 2007). There is a lack of evidence that capnography is more effective than continuous pulse oximetry in the detection of OIRD (Wall, Magee, Campbell, & Zed, 2017). Normal values of end tidal CO 2 range 35 to 45 mm Hg.…”

Section: Oxygen Saturationmentioning

confidence: 99%

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Jungquist

Quinlan-Colwell

Vallerand

et al. 2020

Pain Management Nursing

View full text Add to dashboard Cite

a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

show abstract

Capnography versus standard monitoring for emergency department procedural sedation and analgesia

Abstract: Capnography versus standard monitoring for emergency department procedural sedation and analgesia.

Cited by 16 publications

References 31 publications

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

Efficacy and Safety of Pediatric Procedural Sedation Outside the Operating Room

The addition of capnography to standard monitoring reduces hypoxemic events during gastrointestinal endoscopic sedation: a systematic review and meta-analysis

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

Contact Info

Product

Resources

About