End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study

End-tidal capnometry during emergency department procedural sedation and analgesia: a randomized, controlled study

BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without...

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Published in:World journal of emergency medicine Vol. 7; no. 1; pp. 13 - 18
Main Authors: Campbell, Samuel G, Magee, Kirk D, Zed, Peter J, Froese, Patrick, Etsell, Glenn, LaPierre, Alan, Warren, Donna, MacKinley, Robert R, Butler, Michael B, Kovacs, George, Petrie, David A
Format: Journal Article
Language:English
Published: China World Journal of Emergency Medicine (WJEM) 01-01-2016
Second Affiliated Hospital of Zhejiang University School of Medicine
Subjects:
Airway management
analgesia;Capnography;Adverse
and
Anesthesia
Consent
Drug dosages
Emergency medical care
events;Emergency
Intervention
Intubation
Medical personnel
medicine
Original
Patient safety
Patient satisfaction
Procedural
sedation
Adverse events
Procedural sedation and analgesia
Capnography
Emergency medicine
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Summary:BACKGROUND:This prospective,randomized trial was undertaken to evaluate the utility of adding end-tidal capnometry(ETC)to pulse oximetry(PO)in patients undergoing procedural sedation and analgesia(PSA)in the emergency department(ED).METHODS:The patients were randomized to monitoring with or without ETC in addition to the current standard of care.Primary endpoints included respiratory adverse events,with secondary endpoints of level of sedation,hypotension,other PSA-related adverse events and patient satisfaction.RESULTS:Of 986 patients,501 were randomized to usual care and 485 to additional ETC monitoring.In this series,48%of the patients were female,with a mean age of 46 years.Orthopedic manipulations(71%),cardioversion(12%)and abscess incision and drainage(12%)were the most common procedures,and propofol and fentanyl were the sedative/analgesic combination used for most patients.There was no difference in patients experiencing de-saturation(Sa O2<90%)between the two groups;however,patients in the ETC group were more likely to require airway repositioning(12.9%vs.9.3%,P=0.003).Hypotension(SBP<100 mm Hg or<85 mm Hg if baseline<100 mm Hg)was observed in 16(3.3%)patients in the ETC group and 7(1.4%)in the control group(P=0.048).CONCLUSIONS:The addition of ETC does not appear to change any clinically significant outcomes.We found an increased incidence of the use of airway repositioning maneuvers and hypotension in cases where ETC was used.We do not believe that ETC should be recommended as a standard of care for the monitoring of patients undergoing PSA.
Bibliography:Samuel G.Campbell;Kirk D.Magee;Peter J.Zed;Patrick Froese;Glenn Etsell;Alan La Pierre;Donna Warren;Robert R.Mac Kinley;Michael B.Butler;George Kovacs;David A.Petrie;Department of Emergency Medicine and Anesthesia, Dalhousie University;Faculty of Pharmaceutical Sciences and Department of Emergency Medicine, University of British Columbia;Charles V.Keating Emergency and Trauma Centre;Department of Emergency Medicine, Anesthesia and Anatomy, Dalhousie University
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ISSN:1920-8642
DOI:10.5847/wjem.j.1920-8642.2016.01.002