Capnography for procedural sedation in the ED: a systematic review

Dewdney, Charlotte; MacDougall, Margaret; Blackburn, Rachel C; Lloyd, Gavin; Gray, Alasdair

doi:10.1136/emermed-2015-204944

Cited by 15 publications

(2 citation statements)

References 34 publications

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“…Burton et al (2006) серед пацієнтів, у яких розвивалася депресія дихання під час процедурної седації, капнометрія/капнографія реагувала на 12-271 с раніше, ніж SpO 2 або частота дихання [71]. Утім, великих клінічних досліджень з цього питання проводилося дуже мало, і переконливих даних, чи підвищує капнометрія/капнографія безпеку процедурної седації порівняно зі стандартним моніторингом, на сьогодні недостатньо [72,73].…”

Section: науковий огляд / Scientific Reviewunclassified

Capnometry in the intensive care unit (literature review)

Krishtafor,

Kravets,

Klygunenko

et al. 2023

ЕМ

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Capnometry/capnography is a method of measuring and displaying the concentration of carbon dioxide (CO2) in respiratory gases. Most often, this term involves measuring the partial pressure of carbon dioxide (PCO2) at the end of exhalation (end-tidal CO2, ETCO2). The curve formed during capnography is called a capnogram, where the inspiratory and expiratory segments are distinguished. The main determinants of ETCO2 are CO2 production, cardiac output, pulmonary perfusion, and alveolar ventilation. Normally, ETCO2 is 2–5 mm Hg lower than arterial blood PCO2. This gradient increases when the ventilation-perfusion ratio is impaired, for example, in pulmonary embolism or pulmonary hypoperfusion during cardiac arrest. The shape of the capnogram, in turn, depends on the concentration of CO2 in the alveoli and the pattern of their emptying, as well as on cardiac output. This allows the use of capnography to register bronchospasm, CO2 circulation in the circuit, spontaneous breathing attempts, etc. In Ukraine, capnometry and capnography are routinely used in the anesthesia during laparoscopic surgeries, which require strict control of ETCO2 due to the insufflation of CO2 into the abdominal cavity and its absorption by the peritoneum. However, the spectrum of capnometry application is actually much wider than just laparoscopic surgery. In the intensive care unit, it includes but is not limited to the following indications: confirmation of the endotracheal tube position during tracheal intubation; monitoring the respiratory circuit integrity, including while turning and transporting a patient; evaluation of the cardiopulmonary resuscitation effectiveness; evaluation of the mask ventilation effectiveness; breathing monitoring during procedural sedation; monitoring during mechanical ventilation; auxiliary monitoring of hemodynamics. This literature review discusses the advantages, disadvantages and methods of using capnometry/capnography for each of the listed indications in detail.

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Section: науковий огляд / Scientific Reviewunclassified

Capnometry in the intensive care unit (literature review)

Krishtafor,

Kravets,

Klygunenko

et al. 2023

ЕМ

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“…Although guidelines recommend the use of capnography, a recent systematic review and meta‐analysis showed that the use of capnography was not significantly associated with adverse events 10 . Capnography, along with standard monitoring for patients undergoing PSA in the ED, does not decrease cardiorespiratory events compared with standard monitoring alone 11 .…”

Section: Introductionmentioning

confidence: 99%

Association between capnography and recovery time after procedural sedation and analgesia in the emergency department

Shirane,

Funakoshi,

Takahashi

et al. 2023

Acute Medicine & Surgery

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AimCapnography is recommended for use in procedural sedation and analgesia (PSA); however, limited studies assess its impact on recovery time. We investigated the association between capnography and the recovery time of PSA in the emergency department (ED).MethodsThis study was a secondary analysis of a multicenter PSA patient registry including eight hospitals in Japan. We included all patients who received PSA in the ED between May 2017 and May 2021 and divided the patients into capnography and no‐capnography groups. The primary outcome was recovery time, defined as the time from the end of the procedure to the cessation of monitoring. The log‐rank test and multivariable analysis using clustering for institutions were performed.ResultsOf the 1265 screened patients, 943 patients who received PSA were enrolled and categorized into the capnography (n = 150, 16%) and no‐capnography (n = 793, 84%) groups. The median recovery time was 40 (interquartile range [IQR]: 25–63) min in the capnography group and 30 (IQR: 14–55) min in the no‐capnography group. In the log‐rank test, the recovery time was significantly longer in the capnography group (p = 0.03) than in the no‐capnography group. In the multivariable analysis, recovery time did not differ between the two groups (adjusted hazard ratio, 0.95; 95% confidence interval, 0.77–1.17; p = 0.61).ConclusionIn this secondary analysis of the multicenter registry of PSA in Japan, capnography use did not associate with shorter recovery time in the ED.

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