Capnography Monitoring Research Articles

Monitoring Gas Exchange

Critical illness can threaten the adequacy of O2 delivery or CO2 excretion. Monitoring seeks to identify the adequacy of oxygenation and ventilation and to detect deterioration early. Advances in oximetry, capnography, and transcutaneous CO2 monitoring offer new opportunities for more accurate estimation of gas exchange, noninvasive monitoring of parameters previously not amenable (eg, total hemoglobin measurement), detection of disease, and prediction of fluid responsiveness.

Applicability of Capnography in the Adult ICU During Physical Therapy: A Systematic Review

PurposeThe purpose of this review was three‐fold: first, evaluate the strength and quality of the current research evidence on usage of capnography, second, determine whether current evidence regarding the use capnography during physical therapy should be considered when making decisions regarding patient’s response to physical therapy; and third, identify weaknesses in the current evidence and area for continued research.Background/SignificanceCapnography is typically used in emergency departments and postoperatively but is not commonly used during physical therapy. Pulse oximetry is typically used to monitor oxygen desaturation and hypoxemia during physical therapy but does not predict or monitor respiratory depression. Capnography monitoring during exercise and mobility could have benefits for physical therapists monitoring patients during therapy as well as provide prognostic value of patient progress.Methods and MaterialsA literature search was completed using: Science Direct, IOP Science, PLOS one, Google scholar, Wiley, EBSCO Host, CINAHL Complete, Cochrane Library, and PubMed. Keywords: capnometry, capnography accuracy, physical therapy, application of capnography, mobility, monitoring. Articles selected for review were those of original research or systematic review published since 2009 and evaluated for quality using the Oxford Centre for Evidence‐Based Medicine 2011 levels of evidence system.ResultsTwenty‐seven articles are included for this study. Six articles were included in the introduction. Seven articles examined the current practices for use of capnography; six studies looked at the use of capnography in the intensive care unit. Three articles on pulse oximetry and capnography with mobility, two articles on the use of monitoring ventilation and oximetry during exercise, and three studies on biologically‐based assessment tools for physical therapy.ConclusionsEvidence suggests that monitoring partial pressure end‐tidal carbon dioxide (PETCO2) levels in patients during rest and exercise may provide more prognostic value of possible adverse events in patients with conditions such as heart failure. Monitoring ventilatory responses in patients is valuable in physical therapy as it indicates tolerance to activity. Evidence suggests there is a significant correlation between PETCO2 and cardiac output. Recent research also suggests regardless of mask or cannula used on patients, diagnostic accuracy of measuring PETCO2 is similar during normal and hyper‐ventilatory states. With increasing application of capnography in intensive care settings, studies involving usage in physical therapy are warranted.

Pre-hospital use of capnography during emergency sedation analgesia

Background: Providing optimal patient care in the challenging, uncontrolled, and sometimes hostile pre-hospital environment may require the use of potent analgesics and sedatives. During pre-hospital emergencies, narcotics or sedatives administered for sedation, anxiolysis, or analgesia to allow the patient to tolerate unpleasant procedures, such as traction splint application, can result in cardiovascular and respiratory adverse events.1 Early recognition of poor oxygenation may prevent unnecessary patient hypoxia. The European Society of Anaesthesiology and the American Society of Anaesthesiologist mandate continuous capnography, in addition to standard monitoring which include pulse oximetry, 4-lead ECG, blood pressure, and heart rate measurements.1,2 Capnography refers to the non-invasive measurement of the partial pressure of carbon dioxide (CO2) in exhaled breath. Monitoring respiratory status provides early warning, thereby allowing clinicians to intervene before the onset of respiratory depression, potentially leading to bradypnoea, apnoea, hypoxia, and death.3 In addition, late identification of respiratory failure may lead to unnecessary endotracheal intubation and mechanical ventilation, increasing risk of protracted hospital stay and associated hospital-acquired infections.Oxygenation and ventilation must be measured in both intubated and spontaneously breathing patients. While clinical indicators like chest rise or the plethysmography-derived respiratory rate can be used, monitoring the capnographic waveform for hypopnoeic and bradypnoeic patterns provides the clinician with a quick, accurate indication of acute adverse respiratory events.4 In two randomized trials, patients monitored with capnography in addition to standard of care, experienced significantly fewer episodes of hypoxia than those monitored without capnography.3,5 Hamad Medical Corporation Ambulance Service (HMCAS) in Qatar introduced a new clinical practice guideline (CPG) for safe sedation and monitoring in August 2017, mandating the routine use of capnography for all sedated patients. Safe sedation is achieved when the patient's oxygenation, ventilation, or haemodynamic status is not negatively impacted by the sedation procedure. Methods: The study aimed to describe trends in the use of capnography and other monitoring modalities for patients receiving Ketamine, Fentanyl, or Midazolam. Retrospective quantitative analysis of an existing HMCAS medical records database linked to a Business Intelligence (BI) tool enabled direct analysis on the tool and via a linked Microsoft Excel® spreadsheet, reviewing all emergency cases from 1st January 2017 to 31st December 2018. Frequency analysis and measures of central tendency was applied to the relevant clinical variables. All patient and practitioner identifiable data fields were redacted and not reported on. Results: Oxygen saturation (SpO2) and blood pressure monitoring was used on all patients (n = 5157, 100%), 4-lead ECG was placed on 3710 (72%) patients, while capnography was used on 4096 patients (79%, range = 39% to 99%). Capnography usage steadily improved over the 24-month period, especially for patients receiving Fentanyl (Figure 1). Conclusion: There was a significant improvement in the use of capnography during monitoring of patients that received Fentanyl, Ketamine, or Midazolam, with the most significant improvement for patients receiving Fentanyl alone. Further studies are required to determine the impact of this improvement on actual adverse event frequency.

Pre-apneic capnography waveform abnormalities during procedural sedation and analgesia.

Capnography monitoring is recommended for use during procedural sedation. This study examined associations between capnography waveform abnormalities and the onset of apnea. Capnography waveforms from a sample of 102 participants undergoing moderate procedural sedation with bolus doses of midazolam and fentanyl were analyzed using a mixed effects Cox model. Patients were at increased risk of apnea (classified as end-tidal carbon dioxide concentration of zero) while demonstrating a capnography waveform abnormality classified as hypopnea (more than 10% increase or decrease from baseline end-tidal carbon dioxide concentration) (Hazard Ratio 2.14; 95% CI 1.75 to 2.62). Risk of apnea was not increased during capnography waveform abnormalities classified as bradypnea (capnography-derived respiratory rate less than 8 breaths/min) (Hazard Ratio 0.64; 95% CI 0.33 to 1.25). These estimates were similar when apneic episodes were defined as only those that lasted more than 20 s duration. Deciphering which capnography waveform abnormalities should promote intervention (and therefore alarms to signal the event to clinicians) from those that do not is an essential step towards successful implementation of this technology into practice. Our results indicate that using information about the history of previous capnography waveform abnormalities may be a promising solution to assist prediction of apneic episodes.

Safety of Microstream Capnography Monitoring in Patients Under Sedation for Colonoscopy

Safety of Microstream Capnography Monitoring in Patients Under Sedation for Colonoscopy

Pediatrik özafagogastroduodenoskopi işlemlerinde sedasyon sırasında kullanılan kapnografinin etkinliği: Randomize kontrollü çalışma

Background and Aims: Microstream capnography monitors are devices that use nasal sample lines to measure pulse oximeter and end-tidal carbon dioxide values of spontaneously breathing patients. Research suggests that capnography is a more sensitive measure of ventilation than standard modalities. This study aimed to determine whether adding capnography to standard monitoring improves the detection of respiratory depression in children undergoing esophagogastroduodenoscopy with sedation before hypoxemia occurs. Materials and Methods: We enrolled 100 children undergoing esophagogastroduodenoscopy with sedation in a pediatric endoscopy department. All children received standard monitoring and capnography and were randomized to study (n = 50; capnography monitor) and control (n = 50; blind to monitor) groups. The primary outcome was an oxygen desaturation rate < 90%. Results: The control group had higher rates of hypoventilation and oxygen desaturation per minute and received more interventions than the study group. Untimely interventions with hypoventilation were associated with oxygen desaturation < 90%. All episodes of hypoventilation were due to hypopnea; however, medication, gender, and sedation duration were not significantly associated with this outcome. Conclusion: Hypoventilation is common during sedation of pediatric patients undergoing esophagogastroduodenoscopy. Capnography monitoring provides fewer but timely interventions for apnea and hypoventilation and improves the quality of care during sedation. We, therefore, highly recommend the use of capnography monitoring.

Implementation Science: Incorporating Obstructive Sleep Apnea Screening and Capnography Into Everyday Practice

PurposeThis article describes the implementation and maintenance of obstructive sleep apnea (OSA) screening and capnography monitoring. DesignA quality improvement project. MethodsA multidisciplinary team provided staff education to three perianesthesia care units. Using the STOP-Bang screening tool, five or more positive responses indicated high risk for OSA. A postanesthesia care unit audit tool tracked STOP-Bang scores, capnography use, hypoventilation events, nursing interventions, and respiratory complications. FindingsAmong 314 patients with OSA, 36% were identified as high risk. Nurses used capnography on 76% of OSA patients and were able to readily identify hypoventilation and intervene. Respiratory complications occurred in 10.8% (n = 34) requiring a higher level of care. Postimplementation, all six postanesthesia care units employ this best practice. ConclusionsPerianesthesia nurses found OSA screening and capnography easy to incorporate into nursing practice. This process can reduce respiratory complications in the surgical patient with OSA. An Evidence-Based Practice Fellowship Program facilitated this practice change.

A novel oropharyngeal double lumen cannula for transesophageal echocardiography sedation: a case series

Objectives Most of the ambulatory transesophageal echocardiography (TEE) are performed under sedation with anesthetists’ accompaniment, and often the patency of the airways is a concern. The main objective of this study was to evaluate a novel oropharyngeal cannula during sedation in a case series of adult patients submitted to ambulatory TEE (Figure 1 - Overview of the oropharyngeal double lumen cannula). Methods After approval by the local ethics committee and obtaining written informed consent, 30 adults patients scheduled to undergo elective ambulatory TEE under sedation were included in the study. Exclusion criteria: Body weight Results Preliminary results: procedures undergone without major complications and without severe hypoxia and hypercarbia events. We observed a better patency of the airway, allowing capnography monitoring and a port to oxygen supply. This new device also protected the TEE probe against accidental bites and an anchorage for the probe during the exam. Conclusions The novel double lumen oropharyngeal cannula analyzed in this case series was feasible to be used during ambulatory transesophageal echocardiography.

Prospective Observational Investigation of Capnography and Pulse Oximetry Monitoring After Cesarean Delivery With Intrathecal Morphine

(Anesth Analg. 2019;128:513–522) Neuraxial morphine in low dosages is commonly used to provide high-quality analgesia to women after cesarean delivery. However, postoperative respiratory depression remains a concern, with reported incidences ranging from 0 to 32%. Inadequacy of ventilation and apneas can reliably be detected via capnography but current monitoring relies predominantly on pulse oximetry. No study has evaluated capnography use in women after cesarean delivery. Therefore, in the present study, the authors used capnography to estimate the number of “apnea alert events” (AAEs) in women who underwent cesarean delivery with spinal anesthesia that included 150 µg of intrathecal morphine.

Capnography monitoring of patients with obstructive sleep apnea in the post-anesthesia care unit: a best practice implementation project.

The prevalence of OSA is substantial in North America. Post-operative patients with OSA are at risk for respiratory complications, but about 60% of surgical patients with this condition go undiagnosed. If the presence of sleep apnea is known, non-invasive capnography monitoring can be applied post-operatively to help detect early respiratory compromise during the recovery phase. The STOP-Bang Questionnaire, a validated screening tool to evaluate the risk of OSA, can efficiently be used as part of the pre-surgical evaluation. The aim of this project was to improve safety by averting post-operative respiratory events in patients with obstructive sleep apnea (OSA) through early detection of compromise during recovery from anesthesia. Specific objectives focused on implementing nurse-initiated capnography monitoring of patients with OSA in two post-anesthesia care units and, when indicated, expediently communicating abnormal end-tidal carbon dioxide excursions. Strategies and audit data were organized and evaluated using the Joanna Briggs Institute's Getting Research into Practice (GRiP) and Practical Application of Clinical Evidence Systems (PACES) tools. Medical record review was used for the baseline audit and three follow-up compliance audits of evidence-based practice. Multiple teaching methodologies were employed to reach and engage post-anesthesia care unit nurses. Equipment was maintained at the point of care. Nurses' participation in the project was voluntary. There was nearly full compliance with the new practice of initiating capnography, when indicated. Compliance with escalating abnormal capnography results with associated concerning assessment findings was 100%, but the escalation sample size was only two patients. Patients with known OSA benefited from non-invasive capnography monitoring during recovery from anesthesia because post-anesthesia care unit nurses were empowered to initiate evidence-based technology. Expedient adoption of the new practice was due to comprehensive nurse education, familiarity with a similar capnography monitoring process and the value nurses placed on capnography as another assessment tool to safeguard patients. A larger sample of patients is needed to evaluate compliance with escalating concerning findings to providers. Sustainability will be impacted if the post-anesthesia care unit's standards of care include capnography for patients with OSA.

Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial

The utility of capnography to detect early respiratory compromise in surgical patients after anesthesia is unclear due to limited prospective data. The purpose of this trial was to determine the frequency and duration of capnography-detected respiratory adverse events in the post-anesthesia care unit (PACU). In this prospective observational trial, 250 consenting patients undergoing elective surgery with general anesthesia were monitored by standard monitoring together with blinded capnography and pulse oximetry monitoring. The capnography notification settings were adjusted to match nursing (Level II) and physician (Level I) alarm thresholds. 163 (95%) patients had a Level II notification and 135 (78%) had a Level I notification during standard monitoring. The most common events detected by the capnography monitor included hypocapnia, apnea, tachypnea, bradypnea and hypoxemia, with silent notification duration for these events ranging from 17 ± 13 to 189 ± 127 s. During standard monitoring, 15 respiratory adverse events were reported, with 8 events occurring when valid blinded/silenced capnography and pulse oximetry data was collected simultaneously. Capnography and the Integrated Pulmonary Index™ algorithm (IPI) detected respiratory adverse events earlier than standard monitoring in 75% and 88% of cases, respectively, with an average early warning time of 8 ± 11 min. Three patients’ blinded capnography was unblinded to facilitate clinical care. Respiratory adverse events are frequent in the PACU, and the addition of capnography and IPI to current standard monitoring provides potentially clinically relevant information on respiratory status, including early warning of some respiratory adverse events.Trial registration ClinialTrials.gov Identifier NCT02707003 (https://clinicaltrials.gov/ct2/show/NCT02707003).

MT3 THE EFFECTIVENESS OF CAPNOGRAPHY ON CLINICALLY IMPORTANT OUTCOMES FROM OPIOID-INDUCED RESPIRATORY DEPRESSION: A LITERATURE REVIEW

Undetected opioid-induced respiratory depression (OIRD) is a top ten health technology hazard. It can lead to anoxic brain injury and death. A systematic review showed that capnography detects OIRD better than pulse oximetry; however, the effectiveness of capnography on patient outcomes has not been reviewed. The objective of this study was to review the current state of knowledge on the effectiveness of capnography monitoring on clinically important outcomes. A systematic search of MEDLINE was conducted for literature published between 1946 and September 2018. The Boolean query (“analgesia” OR “patient-controlled analgesia” OR “opioid”) AND (“respiratory depression” OR “respiratory insufficiency” OR “drug overdose” OR “adverse event”) AND (“capnography”) was employed. Additional articles were identified through manual reviews of references. Studies were assessed for relevance, design, setting, and outcomes measured. Of the 56 studies identified, three were eligible for inclusion in the descriptive analysis. A retrospective analysis, of patients receiving PCA or deemed high-risk per clinicians, demonstrated that capnography significantly reduced incidence of OIRD requiring rapid response team activation (0.04% vs. 0.02%, p < 0.0001) and unplanned transfers to the ICU (7.6 transfers/month vs. 1.6 transfers/month). A case report, of patients ordered parenteral opioids and receiving supplemental oxygen, observed a 33% reduction in severe OIRD events (4.2 events/quarter vs. 2.8 events/quarter) post-implementation of capnography. Another case report, of medical-surgical patients deemed high-risk per clinicians, found that OIRD events resulting in respiratory arrest were eliminated after hospital initiatives increased uptake of capnography monitoring. Overall, continuous capnography increased patient safety with reductions in severe OIRD events, rapid response team activation, and transfers to higher levels of care. Capnography is associated with reductions in clinically important patient outcomes and associated healthcare utilization. Future research to develop a tool to systematically identify high-risk patients, that would benefit most from capnography monitoring, is needed.

Comparison of Pulse Oximetry and Capnography Monitoring with Arterial Blood Gases Parameters among Postoperative Pediatric Cardiac Surgeries at a University Hospital

Comparison of Pulse Oximetry and Capnography Monitoring with Arterial Blood Gases Parameters among Postoperative Pediatric Cardiac Surgeries at a University Hospital

Criteria for the duration of anti-inflammatory therapy in children with bronchopulmonary dysplasia

Objective. To develop criteria for determining the duration of anti-inflammatory therapy and indications for withdrawal of inhaled corticosteroids (ICS) in children with bronchopulmonary dysplasia (BPD). Materials and methods . A total of 56 premature infants with moderate to severe (group 1) and severe (group 2) “classical” bronchopulmonary dysplasia (BPD) who received inhaled budesonide were examined. The groups of children were comparable for gestational age, birth weight and matched for gender. The effectiveness of therapy was evaluated according to the dynamics of clinical manifestations, monitoring of blood oxygen saturation (SаO 2 ) at rest and during exercise, capnographic monitoring and chest radiography changes. Results . Monthly observation of children with BPD during the year showed symptoms resolution in all children in the course of anti-inflammatory ICS therapy (on average within 2.5 months in the children of group 1 and within 4.5 months in the children of group 2), and then the parameters of SаO 2 were normalized (on average within 3 and 5.5 months, respectively). Capnographic changes remained longer (from 3 to 12 months). Chest radiographs showed changes within a period from 9 to 12 months and these changes did not always correspond to the symptoms resolution. The conducted factor analysis allowed to identify the criteria for withdrawal of anti-inflammatory therapy. The most significant criteria were the normalization of respiratory rate and reduction in dyspnea, a decrease in SaO 2 less than 10 % during exercise, a decrease in unevenness of ventilation-perfusion relations and expiratory time according to T in /T ex ratio. Changes in the chest radiographs did not have a significant effect on the duration of anti-inflammatory therapy in children with BPD. Conclusions. Thus, the duration of ICS therapy should be individualized taking into account the severity of BPD, the dynamics of clinical manifestations, and the indicators of pulse oximetry at rest and during exercise. Capnography monitoring in children with BPD provides an opportunity to assess objectively the dynamics of bronchial obstruction resolution and to determine the individual terms for withdrawal of ICS. Constant X-ray control is not necessary at the outpatient stage of treatment for children with BPD, as the signs of radiographic recovery are slow and do not influence the choice and duration of anti-inflammatory therapy.

Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital.

ObjectivesThe use of opioid analgesics for pain management in hospitalized patients is associated with a high risk of adverse events, including respiratory depression which may lead to respiratory arrest and death. Patients who experience opioid-related adverse drug reactions (ADRs) have been shown to experience longer and more costly hospital stays and have a higher risk of requiring a readmission after discharge. In this study, we report on the impact of the introduction of Wesley Medical Center's Safe Medication Practice Protocol on opioid-related ADRs.MethodsA retrospective, pre-post cohort study using electronic health records combined with manual chart review was undertaken at the Wesley Medical Center, a 760-bed tertiary care facility. The Safe Medication Practice Protocol incorporating a smart infusion pump system with capnography monitoring was implemented in May 2010 hospital-wide. The number and severity of ADRs and the duration of opioid treatment were compared between the pre (2007-April 2010) and post (May 2010–2014) periods.ResultsA total of 139,734 (pre-period) versus 267,573 (post-period) patients received opioid treatment during the hospital stay. Compared with the pre-period, the post-period resulted in a 79.2% reduction in the number of severe adverse reactions (3.08 vs 0.64 per 10,000 patients treated with opioid, P < 0.0001) as well as a shorter duration of opioid treatment (average 2.05 vs 1.37 days, P < 0.0001).ConclusionsImplementing education, revisions to patient-controlled analgesia policies and procedures, and capnography monitoring with patient-controlled analgesia pause is associated with significantly lower rates of severe ADRs and shorter opioid treatment duration.

Two-site regional oxygen saturation and capnography monitoring during resuscitation after cardiac arrest in a swine pediatric ventricular fibrillatory arrest model.

AbstarctTo investigate the use of two-site regional oxygen saturations (rSO2) and end tidal carbon dioxide (EtCO2) to assess the effectiveness of resuscitation and return of spontaneous circulation (ROSC). Eight mechanically ventilated juvenile swine underwent 28 ventricular fibrillatory arrests with open cardiac massage. Cardiac massage was administered to achieve target pulmonary blood flow (PBF) as a percentage of pre-cardiac arrest baseline. Non-invasive data, including, EtCO2, cerebral rSO2 (C-rSO2) and renal rSO2 (R-rSO2) were collected continuously. Our data demonstrate the ability to measure both rSO2 and EtCO2 during CPR and after ROSC. During resuscitation EtCO2 had a strong correlation with goal CO with r = 0.83 (p < 0.001) 95% CI [0.67–0.92]. Both C-rSO2 and R-rSO2 had moderate and statistically significant correlation with CO with r = 0.52 (p = 0.003) 95% CI (0.19–0.74) and 0.50 (p = 0.004) 95% CI [0.16–0.73]. The AUCs for sudden increase of EtCO2, C-rSO2, and R-rSO2 at ROSC were 0.86 [95% CI, 0.77–0.94], 0.87 [95% CI, 0.8–0.94], and 0.98 [95% CI, 0.96–1.00] respectively. Measurement of continuous EtCO2 and rSO2 may be used during CPR to ensure effective chest compressions. Moreover, both rSO2 and EtCO2 may be used to detect ROSC in a swine pediatric ventricular fibrillatory arrest model.

Correlation of End-Tidal Carbon Dioxide Tension with Arterial Carbon Dioxide Tension in Patients with Respiratory Failure on Mechanical Ventilation

Background: Patients undergo mechanical ventilation need continuous evaluation of their respiratory condition. Monitoring of end-tidal carbon dioxide (ETCO2) as noninvasive measurement of arterial carbon dioxide (PaCO2) is a good tool for assessment and management of mechanically ventilated patients. Aim of the work: The aim of this work is to correlate expiratory end-tidal carbon dioxide tension with arterial carbon dioxide tension in patients with respiratory failure on mechanical ventilation and its significance. Patients and methods: This study was carried out on 50 patients on invasive mechanical ventilation with acute or acute on top of chronic respiratory failure admitted to respiratory I.C.U. at Bab El- Shaeria University Hospital, Studied patients had obtained two ABG samples one at the onset of mechanical ventilation(M.V.) and the second when the patient was on weaning mode of mechanical ventilation with continuous capnographic monitoring and reading record at the onset of ABG sampling. Results: The study include 31 males (62%),and 19 female (38%),24 patients (48%) had C.O.P.D, 9 patients (18%) had pneumonia, 8 patients (16%) had O.H.S, 7 patients (14%) had I.L.D and2 patients (4%) had acute severe asthma. The study shows no statistical significant difference between PaCO2 and ETCO2 at the onset of mechanical ventilation (74.78 ± 20.19 and67.5 ± 19.23) mmHg and on weaning mode (43.98 ± 8.07 and 42.2±7.2) mmHg. that PaCO2 measurements vary approximately 2-7 mmHg above ETCO2 values which mean good correlation between PaCO2 and ETCO2. Conclusion: - ETCO2 measurement provides an accurate estimation of PaCO2 in ventilation and weaning which may reduce the need for invasive, high coast monitoring and repeated arterial blood gas analyses.

Capnography Monitoring for Patients Undergoing Moderate Sedation: An SGNA Fellowship Project.

The purpose of this Society of Gastroenterology Nurses and Associates Fellowship project was to determine whether capnography is more accurate than oximetry in identifying symptoms of respiratory depression in patients undergoing moderate sedation. Capnography provides an early warning of respiratory depression and airway compromise, especially when the medications used for sedation include opiates and benzodiazepines. It is a standard of care according to the American Society of Anesthesiologists that should be adopted in order to provide the safest possible environment for the delivery of moderate sedation. During this project, the nursing staff were educated on the importance and usage of capnography. Evidence was gathered that helped show that by using capnography, nurses were able to identify signs of respiratory depression earlier and more frequently than with the use of oximetry and cardiac monitoring alone.

Capnography Monitoring During Procedural Sedation and Analgesia.

Procedural sedation is used to alleviate pain and anxiety associated with diagnostic procedures in the acute care setting. Although commonly used, procedural sedation is not without risk. Key to reducing this risk is early identification of risk factors through presedation screening and monitoring during the procedure. Electrocardiogram, respiratory rate, blood pressure, and pulse oximetry commonly are monitored. These parameters do not reliably identify airway and ventilation compromise. Capnography measures exhaled carbon dioxide and provides early identification of airway obstruction and hypoventilation. Capnography is useful in patients receiving supplemental oxygen. In these patients, oxygen desaturation reported by pulse oximetry may lag during episodes of respiratory depression and apnea. Capnography indicates partial pressure of end-tidal carbon dioxide and provides information regarding airway integrity and patterns of ventilation compromise. Implementation of this technology may provide an additional layer of safety, reducing risk of respiratory compromise in patients receiving procedural sedation.

Post-op capnography monitoring

Early identification of opioid-induced respiratory depression is a collaborative effort that requires the dedication of the healthcare team to increase patient safety outcomes.