Service Evaluation of the Impact of Capnography on the Safety of Procedural Sedation

Abstract

BackgroundCapnography has been associated with a reduced incidence of events related to respiratory compromise during procedural sedation.MethodsA prospective service evaluation was conducted at a large United Kingdom (UK) teaching hospital to assess the impact of capnography on patient safety within four speciality services: bronchoscopy, endoscopy, interventional cardiology, and interventional radiology. Events were defined as provided by the World Society of Intravenous Anaesthesia. One thousand four hundred one patients were enrolled in the evaluation, with 666 patients before and 735 after implementation of capnography. Data was entered as a convenience sample on site in an offline data-collection tool. Results were assessed for the relative reduction in the incidence and resulting adjusted odds ratio for the combined incidence of oxygen desaturation (75–90% for <60s), severe oxygen desaturation (<75% at any time) or prolonged oxygen desaturation (<90% for >60s), bradycardia (>25% from baseline) and tachycardia (>25% from baseline). The adjusted odds ratio was controlled for both procedure and patient characteristics.ResultsAfter implementation of capnography, a significant reduction (43.2%, p ≤ 0.05) in adverse events was observed: 147 adverse events occurred during 666 procedures without capnography compared with 93 adverse events that occurred during 735 procedures with capnography. The adjusted odds ratio for the occurrence of the target adverse events was 0.57 (95% CI: 0.42–0.77). Multivariable linear regression indicated that capnography was a significant predictor (p 0.001) of reduced adverse events.ConclusionThese results suggest improved patient safety following capnography implementation.

Continuous Capnography for Early Detection of Respiratory Compromise During Gastroenterological Procedural Sedation and Analgesia

“…A systematic review and meta-analysis of 13 RCTs published from 2006 to 2016 found that capnography-guided care halved the odds of needing assisted ventilation during ambulatory surgical procedures (Saunders et al, 2017). A large study conducted across four specialties (bronchoscopy, endoscopy, interventional cardiology, and interventional radiology) at a teaching hospital in the United Kingdom determined the effect of capnography implementation during PSA on the combined incidence of oxygen desaturation, severe oxygen desaturation, prolonged desaturation, bradycardia, and tachycardia (Corbett et al, 2022). Implementation resulted in a 42% reduction in adverse events overall, even after accounting for specialty, ASA status, and use of supplemental oxygen.…”

Safety and quality in paediatric procedural sedation: what really matters?

“…Temperature monitoring, blood gas analysis and invasive monitoring of blood pressure are reserved for special indications. Numerous studies have tried to demonstrate the benefits of capnography for detecting apnoea before desaturation during procedural sedation in children and adults with inconsistent results [24][25][26]. Clinical experience suggests that capnography is a simple and valuable additional monitoring tool, which may be most efficient in settings, wherein the child and its respiration are not under direct clinical observation.…”