Abstract
Problem identification Capnography monitoring has been identified as a valuable monitoring tool to assist in the early detection of respiratory adverse events in post-operative patients in the PACU who are receiving supplemental oxygen. This integrated review of literature aims to identify the usefulness of implementing capnography monitoring in the PACU as standard practice to ensure safe patient outcomes. Literature search A search was undertaken of Scopus, Cumulative Index Nursing and Allied Health Literature (CINAHL) Complete, Health Source: Nursing and Academic Edition, Clinical Key, PubMed and MEDLINE Complete electronic databases. Articles (n=12) were selected for this review including a randomised control trial (RCT), quality improvement projects, a prospective observation study, a prospective cross-sectional study, an evidence summary and a systematic review and meta-analysis study. Data evaluation synthesis The main indicators for the use of capnography in the PACU included patients on assisted oxygen, patients receiving opioid analgesia, patients with obstructive sleep apnoea and paediatric patients. All articles related to capnography presented complimentary findings regarding the usefulness of capnography monitoring and its implementation in the PACU. Implications for perioperative nursing practice or research Capnography is effective in identifying compromised ventilation in post-operative patients who are receiving supplemental oxygen in the PACU, compared to the use of pulse oximetry alone. The literature recommends the combined use of pulse oximetry and capnography in the post-operative period to provide clinicians with a complete assessment of a patients ventilatory status. Nursing education is indicated to improve respiratory assessments and monitoring skills of PACU nurses combined with further research to ensure the effective implementation of capnography in the PACU.
Highlights
Capnography is a method for monitoring the partial pressure of carbon dioxide in the blood and end tidal capnography measures the partial pressure of carbon dioxide at the end of an exhaled breath[1], i.e. end tidal carbon dioxide (ETCO2)
The Australian and New Zealand College of Anaesthetists (ANZCA) PS04 Statement on the Post Anaesthesia Care Unit states that capnography monitoring must be applied to patients with an endotracheal tube and must be available if a patient is intubated or requires intubation in the PACU6
Chung et al concluded that the addition of capnography to standard PACU monitoring would be valuable in the early detection of respiratory adverse events[2]
Summary
Capnography is a method for monitoring the partial pressure of carbon dioxide in the blood and end tidal capnography measures the partial pressure of carbon dioxide at the end of an exhaled breath[1], i.e. end tidal carbon dioxide (ETCO2). This observation is non-invasive and occurs through a gas sampling line attached to a mask or nasal prongs in the spontaneously breathing patient[2]. Respiratory depression, referred to as hypoventilation, is slow and ineffective breathing which can lead to increasing carbon dioxide levels in the blood (hypercapnia) and low blood oxygen levels (hypoxaemia)[1]. Very early signs of malignant hyperthermia are heralded by an exponential increase in ETCO2 levels; capnography may assist in faster detection of this lifethreatening event[5]
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