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Introduction

The use of procedural sedation and analgesia (PSA) during non-surgical and minor surgical procedures is increasing. Significant adverse events associated with PSA are relatively rare but not inconsequential. Inadequate oxygenation was the most frequent event leading to a PSA-related claim, the median cost of settlement being $330.000. Monitoring during PSA is mandatory to maintain patient safety.

Research question

Can monitoring patient ventilation with continuous capnography improve patient safety during PSA?

Capnography Monitoring
Methodology

Meta-analysis

Combine multiple evidence sources (usually randomized, controlled trials) into a single estimate of relative efficacy and/or safety to determine which product is the most efficacious/safe for use in the analyzed setting.

Evidence identification

Systematic, structured searches of PubMed, the Cochrane Library and EMBASE, returned literature published in or after 1995, reporting results for randomized, controlled trials in patients receiving sedation for outpatient procedures. From 1,006 articles, 13 were included for analysis (Figure).

Analysis

The primary endpoint was desaturation/hypoxemia. Relative efficacy of capnography was calculated as the pooled mean risk ratio (RR) versus standard of care.

systematic structured searches
Results
  • Capnography monitoring significantly reduced the risk of mild and severe oxygen desaturation (Figure).

 

  • The risk of severe desaturation was reduced by over 40% with capnography.

 

  • Increase in patient safety with capnography was also evidenced by the significant reduction in use of bag-mask assisted ventilation.
capnography meta-analysis-plot
Study take-away messages
  • Capnography increases patient safety during PSA.

 

  • Substantial and significant reduction in oxygen desaturation events are linked to the use of capnography monitoring.

 

  • Improved patient safety can reduce the cost of care and limit legal liability.
capnography map RCT