Ensuring Safety of Patients Receiving Sedation for Procedures: Evaluation of Clinical Practice Guidelines

Poe, Stephanie; Nolan, Marie T.; Dang, Deborah; Schauble, James F.; Oechsle, Denise; Kress, Laura; Larkins, Jane; Feroli, E. Robert; Walker, Allan David; Maxwell, Lynne G.

doi:10.1016/s1070-3241(01)27004-7

Cited by 25 publications

(20 citation statements)

References 19 publications

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“…9,[11][12][13]40 The results of this controlled trial suggest that microstream capnography improves the current standard of care for monitoring sedated children by allowing early detection of respiratory compromise, prompting intervention to minimize hypoxemia. Used in conjunction with pulse oximetry and visual assessment, capnography may ultimately improve patient safety during moderate sedation for pediatric procedures.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Investigative efforts to improve monitoring during sedation for patients of all ages are part of a national agenda for patient safety. 2,5,9 Continuous pulse oximetry in conjunction with visual assessment is the current standard of care for patient monitoring during pediatric moderate sedation. [10][11][12] The American Society of Anesthesiologists and the Joint Commission on Accreditation of Healthcare Organizations have defined moderate sedation as a drug-induced depression of consciousness along the continuum of sedation that maximizes comfort and cooperation without compromising airway integrity.…”

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confidence: 99%

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Microstream Capnography Improves Patient Monitoring During Moderate Sedation: A Randomized, Controlled Trial

et al. 2006

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The results of this controlled effectiveness trial support routine use of microstream capnography to detect alveolar hypoventilation and reduce hypoxemia during procedural sedation in children. In addition, capnography allowed early detection of arterial oxygen desaturation because of alveolar hypoventilation in the presence of supplemental oxygen. The current standard of care for monitoring all patients receiving sedation relies overtly on pulse oximetry, which does not measure ventilation. Most medical societies and regulatory organizations consider moderate sedation to be safe but also acknowledge serious associated risks, including suboptimal ventilation, airway obstruction, apnea, hypoxemia, hypoxia, and cardiopulmonary arrest. The results of this controlled trial suggest that microstream capnography improves the current standard of care for monitoring sedated children by allowing early detection of respiratory compromise, prompting intervention to minimize hypoxemia. Integrating capnography into patient monitoring protocols may ultimately improve the safety of nonintubated patients receiving moderate sedation.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Microstream Capnography Improves Patient Monitoring During Moderate Sedation: A Randomized, Controlled Trial

et al. 2006

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“…[41][42][43][44] This revised statement reflects the current understanding of appropriate monitoring needs both during and after sedation for a procedure. 4,5,12,19,21,22,26,[45][46][47][48][49][50][51][52][53] The monitoring and care outlined in these guidelines may be exceeded at any time on the basis of the judgment of the responsible practitioner. Although intended to encourage high-quality patient care, adherence to these guidelines cannot guarantee a specific patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Coté¹,

Wilson²

2006

Pediatrics

517

150

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The safe sedation of children for procedures requires a systematic approach that includes the following: no administration of sedating medication without the safety net of medical supervision; careful presedation evaluation for underlying medical or surgical conditions that would place the child at increased risk from sedating medications; appropriate fasting for elective procedures and a balance between depth of sedation and risk for those who are unable to fast because of the urgent nature of the procedure; a focused airway examination for large tonsils or anatomic airway abnormalities that might increase the potential for airway obstruction; a clear understanding of the pharmacokinetic and pharmacodynamic effects of the medications used for sedation, as well as an appreciation for drug interactions; appropriate training and skills in airway management to allow rescue of the patient; age-and size-appropriate equipment for airway management and venous access; appropriate medications and reversal agents; sufficient numbers of people to carry out the procedure and monitor the patient; appropriate physiologic monitoring during and after the procedure; a properly equipped and staffed recovery area; recovery to presedation level of consciousness before discharge from medical supervision; and appropriate discharge instructions. This report was developed through a collaborative effort of the American Academy of Pediatrics and the American Academy of Pediatric Dentistry to offer pediatric providers updated information and guidance in delivering safe sedation to children. INTRODUCTIONInvasive diagnostic and minor surgical procedures on pediatric patients outside the traditional operating room setting have increased in the last decade. As a consequence of this change and the increased awareness of the importance of providing analgesia and anxiolysis, the need for sedation for procedures in physician offices, dental offices, subspecialty procedure suites, imaging facilities, emergency departments, and ambulatory surgery centers has also markedly increased. In recognition of this need for both elective and emergency use of sedation in nontraditional

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“…As an alternative approach, in an effort to improve the outcome of jLN, members of CARRA developed CTPs which allow for the standardization of jLN therapy. The experience from other adult and pediatric diseases suggests that standardization of care using CTPs has the potential to improve disease outcomes 42–44 . This is because CTPs promote the provision of therapies using the best available scientific knowledge, and allow for the conduct of comparative effectiveness analyses that can further elucidate the most effective treatment approach.…”

Section: Discussionmentioning

confidence: 99%

Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus

Mina

Scheven

Ardoin

et al. 2012

Arthritis Care & Research

181

122

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Objective To formulate consensus treatment plans (CTPs) for induction therapy of newly-diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (jSLE). Methods A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) after considering the existing medical evidence and current treatment approaches. Results After an initial Delphi survey (response rate 70%), a 2-day consensus conference, and two follow-up Delphi surveys (response rates 63–79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypic patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized doses for six months. Additionally, the CTPs describe three options for standardized use of glucocorticoids; including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. Conclusion CTPs for induction therapy of proliferative LN in jSLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in jSLE.

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Ensuring Safety of Patients Receiving Sedation for Procedures: Evaluation of Clinical Practice Guidelines

Cited by 25 publications

References 19 publications

Microstream Capnography Improves Patient Monitoring During Moderate Sedation: A Randomized, Controlled Trial

Microstream Capnography Improves Patient Monitoring During Moderate Sedation: A Randomized, Controlled Trial

Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures: An Update

Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus

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