Characteristics of and Predictors for Apnea and Clinical Interventions During Procedural Sedation

Unscheduled Procedural Sedation: A Multidisciplinary Consensus Practice Guideline

“…Given continued advances in ventilatory monitoring technology and real-time computational data analysis and algorithm development, it seems highly likely that responsiveness-defined sedation levels will be replaced in many procedures with objective physiological monitoring that continually predicts the ongoing risk of serious ventilatory impairment. 49,50,55 Procedural Sedation Depth, Not Drug A longstanding hallmark of procedural sedation guidelines is the concept of a sedation continuum, ie, that all sedatives and opioids, excluding ketamine-depending upon dose and patient response-are capable of producing any sedation depth along this scale from minimal sedation to general anesthesia. Accordingly, it is more meaningful and useful to focus clinical decisions and management upon sedation depth and ventilatory adequacy rather than the specific drug itself, recognizing that different drugs have different pharmacological properties and windows of effect and side effect.…”

“…16 Capnography is simple, noninvasive, easy to interpret, provides the earliest warning of hypoventilation and apnea, and its use can reduce the risk of developing hypoxia. 2,3,16,55 Normal capnography can quickly and unambiguously confirm ventilatory activity. Abnormal capnography can signal clinicians to reevaluate their patients, to be prepared to provide ventilatory support and/or to administer a reversal agent, and to avoid administering additional doses of sedatives until the concern is resolved.…”

“…Abnormal capnography can signal clinicians to reevaluate their patients, to be prepared to provide ventilatory support and/or to administer a reversal agent, and to avoid administering additional doses of sedatives until the concern is resolved. 55 Capnography also permits clinicians to safely administer supplemental oxygen (discussed below).…”

“…As noted earlier, the next few years will hopefully permit movement beyond our current responsiveness-based cognitive framework for the sedation continuum, and shift our focus from sedation depth to sedation risk. 49,50,55 The application of computational tools for analysis of continuous, high-resolution monitoring data may permit ongoing, real-time estimates of risk, allowing clinicians to titrate drug administration and focus interactive monitoring based upon such risk assessments rather than upon repeated patient stimulation. 49,50,55 We gratefully thank Travis Schulz, MLS, AHIP, for his tremendous support in this project.…”

Epidemiology and Mortality Predictors for Severe Childhood Pneumonia in ICUs: A Real-World Study in China

“…Therefore, sedative-hypnotics were generally not recommended for severe childhood pneumonia. If necessary, arterial blood gas measurement should be performed regularly to monitor End tidal CO 2 , and the children are at risk of apnea when the End tidal CO 2 is < 30 mmHg or > 50mmHg 32 . What is more, probiotics were independently associated with a reduced risk of death, which was alike to the result of a prospective multicenter RCT carried out in 9 NICUs from Colombia, in which the investigator observed a lower morbidity and mortality of nosocomial infection in the probiotic group, including pneumonia 19 .…”