Capnography monitoring during procedural sedation and analgesia: a systematic review protocol.

Aaron Conway,Clint Douglas,Joanna Sutherland

doi:10.1186/s13643-015-0085-4

Abstract

BackgroundAn important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inadequate oxygenation/ventilation is the most common reason for injury associated with PSA, reducing episodes of hypoxaemia would indicate that using capnography would be safer than relying on standard monitoring alone.Methods/designThe primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO2] less than 90 %). A secondary objective of this review is to determine whether changes in the clinical management of sedated patients are the mediating factor for any observed impact of capnography monitoring on the rate of hypoxaemia. The potential adverse effect of capnography monitoring that will be examined in this review is the rate of inadequate sedation. Electronic databases will be searched for parallel, crossover and cluster randomised controlled trials comparing the use of capnography with standard monitoring alone during PSA that is administered in the hospital setting. Studies that included patients who received general or regional anaesthesia will be excluded from the review. Non-randomised studies will be excluded. Screening, study selection and data extraction will be performed by two reviewers. The Cochrane risk of bias tool will be used to assign a judgment about the degree of risk. Meta-analyses will be performed if suitable.DiscussionThis review will synthesise the evidence on an important potential clinical benefit of capnography monitoring during PSA within hospital settings.Systematic review registrationPROSPERO CRD42015023740Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-015-0085-4) contains supplementary material, which is available to authorized users.

Highlights

One important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing short-term serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation
As inadequate oxygenation/ventilation is the most common reason for injury associated with PSA, reducing episodes of hypoxaemia would indicate that using capnography would be safer than relying on standard monitoring alone [11]
The primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia

Summary

Introduction

An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. PSA is generally considered to include the stages of moderate and deep sedation of the continuum of anaesthesia [1]. PSA is still associated with at the least the same or potentially even greater risk of serious sedation-related adverse events, such as death or permanent neurological disability, compared with general anaesthesia [2]. Due to the potential that respiratory function may become impaired as a result of sedation-induced depression of the central nervous system, frequent monitoring is recommended [1, 3]. In the UK, the Academy of Medical Royal Colleges Standards and Guidance for Safe Sedation Practice for Healthcare Procedures include capnography as a developmental standard for patients receiving sedation where it has not already been implemented into practice

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