Capnography monitoring of physician-led procedural sedation procedures during respiratory medicine service

Abstract

<b>Introduction:</b> Capnography is part of monitoring for procedural sedation in selected endoscopic procedures at Cambridge University Hospitals NHS Foundation Trust and shows potential benefit through earlier detection of respiratory compromise. <b>Aims and objectives:</b> Gastroenterology (GI), interventional cardiology (IC), and vascular access (VA), respiratory medicine (RM) services undertook a quality of care improvement initiative to quantify the effect of using capnography as part of standard monitoring, on procedure safety. <b>Methods:</b> The cumulative endpoint was the incidence of oxygen desaturation (&lt;75% any duration, 75-90% &lt;60 seconds(s), &lt;90% &gt;60s), bradycardia, and tachycardia (&gt;25% change from baseline). We targeted a 20% reduction in this cumulative endpoint post capnography implementation. Data was collected between December 2017 and January 2020 and results were collected on-site in an Excel-based data tool. No patient identifiers were recorded. <b>Results:</b> Data from 1,401 procedures across the GI, IC, and RM services were collected. The first 666 procedures were pre-capnography, and following 735 procedures post-capnography. A 42% (p&lt;0.05) reduction in the incidence of the cumulative endpoint was recorded with capnography. Of the 129 bronchoscopic procedures, there were 0.59 events in the 73 pre-capnography group and 0.46 events in the 56 post-capnography group. This is a 21% percent reduction in the cumulative endpoint. <b>Conclusions:</b> With capnography monitoring, a 21% reduction in adverse events was recorded during RM procedures. GI, IC, and RM services support including capnography monitoring in the hospital’s sedation guidelines.