Use of Capnography to Optimize Procedural Sedation in the Emergency Department Pediatric Population

Abstract

•Waveform capnography is a continuous measurement and graphical display of the carbon dioxide (CO2) levels throughout inspiration and expiration. It varies in accordance with a patient’s respiratory rate and tidal volume. During pediatric procedural sedation and analgesia (PSA), waveform capnography can indicate abnormal ventilation before it can be detected through physical assessment of ventilation or by pulse oximetry. •The weight of a few small, single-center, randomized controlled trials and observational studies suggest a benefit to the use of this technology. However, additional and larger studies are needed to elucidate a more substantial basis to inform best nursing practice. •Emergency nurses should be engaged in assessing all appropriate sources of data to determine whether use of capnography during PSA improves patient outcomes. •Waveform capnography is a continuous measurement and graphical display of the carbon dioxide (CO2) levels throughout inspiration and expiration. It varies in accordance with a patient’s respiratory rate and tidal volume. During pediatric procedural sedation and analgesia (PSA), waveform capnography can indicate abnormal ventilation before it can be detected through physical assessment of ventilation or by pulse oximetry. •The weight of a few small, single-center, randomized controlled trials and observational studies suggest a benefit to the use of this technology. However, additional and larger studies are needed to elucidate a more substantial basis to inform best nursing practice. •Emergency nurses should be engaged in assessing all appropriate sources of data to determine whether use of capnography during PSA improves patient outcomes. Leonie Rose Bovino, Member, ENA Connecticut State Council, is Assistant Professor, Quinnipiac University School of Nursing, Hamden, CT. Christina Brainard is Nursing Student at Quinnipiac University School of Nursing, Hamden, CT. Kristen Beaumier is Nurse at Quinnipiac University School of Nursing, Hamden, CT. Victoria Concetti is Nurse at Quinnipiac University School of Nursing, Hamden, CT. Nicole Lefurge is Nurse at Quinnipiac University School of Nursing, Hamden, CT. Emily Mittelstadt is Nurse at Quinnipiac University School of Nursing, Hamden, CT. Tabea Wilson is Nurse at Yale New Haven Hospital, New Haven, CT. Melissa L. Langhan is Physician at Yale New Haven Hospital, New Haven, CT, and Associate Professor, Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT.