What are the risks of procedural sedation?

During procedural sedation, there’s often a concern that a sedated patient’s spontaneous ventilation may become inadequate. And clinical evidence suggests that a patient’s sedation level does not remain stable during a procedure, and may change dangerously from moderate to deep([FOOTNOTE=Frank RL. Procedural sedation in adults outside the operating room. https://www.uptodate.com/contents/procedural-sedation-in-adults-outside-the-operating-room, accessed on 2021-05-20],[ANCHOR=],[LINK=]) – which can have an impact on their ability to breathe.

When you consider that only half of moderately sedated patients achieve their target level of sedation([FOOTNOTE=Schick A, Driver B, Moore JC, Fagerstrom E, Miner JR. Randomized Clinical Trial Comparing Procedural Amnesia and Respiratory Depression Between Moderate and Deep Sedation With Propofol in the Emergency Department. Acad Emerg Med. 2019 Apr;26(4):364-374. doi: 10.1111/acem.13548. Epub 2018 Sep 24. PMID: 30098230.],[ANCHOR=],[LINK=]), and that similar patients can react differently to a similar sedative dose, the risks become more apparent.

RESPIRATORY EVENTS ARE MORE PREVALENT THAN YOU MAY THINK

  • Only 50% of moderately sedated patients achieved their target level.2
  • 20% of patients experienced respiratory related events requiring interventions.([FOOTNOTE=Saunders R, Davis JA, Kranke P, Weissbrod R, Whitaker DK, Lightdale JR. Clinical and economic burden of procedural sedation-related adverse events and their outcomes: analysis from five countries. Ther Clin Risk Manag. 2018 Feb 28;14:393-401. doi: 10.2147/TCRM.S154720. PMID: 29535525; PMCID: PMC5836671.],[ANCHOR=],[LINK=])

What is the advice for capnography during procedural sedation?

In the past, there has been some confusion about the advice of clinical societies with regard to capnography. However, there is a growing wave of societies recommending continuous capnography along with pulse oximetry, as an alert to changes in oxygenation and ventilation – two key factors in detecting respiratory related adverse events in their early stages.([FOOTNOTE=Clinical Society Guidelines for Capnography Monitoring. 18-emea-cs-guidelines-for-capnography-2922293.pdf. 2019],[ANCHOR=],[LINK=])

In fact, more than 65 scientific and clinical societies now consider capnography as the standard of care – and recommend its use during procedural sedation.4

CAPNOGRAPHY CAN HELP YOU TO REDUCE THESE RESPIRATORY RELATED EVENTS

  • The incidence of respiratory adverse events can decrease by up to 55% with capnography.([FOOTNOTE=Bisschops R, Saunders R, Dooms C, Hoffman I, van der Merwe S, Weissbrod R, Torres RT, Van Assche G, Demedts I. Implementing capnography to help improve patient safety during procedural sedation: quality improvement in a high-volume gastroenterology department. Eur J Gastroenterol Hepatol. 2021 Apr 19. Doi: 10.1097/MEG.0000000000002144. Epub ahead of print. PMID: 33905213.],[ANCHOR=],[LINK=])
  • Capnography is considered as the standard of care, by over 65 clinical societies.4

Capnography in Guidelines

To help you understand the advice, Medtronic has produced an eBook on Clinical Society Guidelines for Capnography Monitoring, enabling you to:

  • Read about some of the clinical societies publishing guidelines and standards for capnography monitoring
  • View guideline and recommendation summaries
  • Gain insight on specific recommendations 

DOWNLOAD THE EBOOK

Would you like to optimize your patients' monitoring during procedural sedation?

Contact us to learn more about the solutions Medtronic has available: we can help you understand the positive impact that effective capnography monitoring could have on your organisation, and the patients you care for.

Is there an unjustified barrier to the use of capnography?

Despite respiratory events being the most common adverse event associated with procedural sedation([FOOTNOTE=Frank RL. Procedural sedation in adults outside the operating room. https://www.uptodate.com/contents/procedural-sedation-in-adults-outside-the-operating-room, accessed on 2021-05-20],[ANCHOR=],[LINK=]), there are still objections to the use of capnography on the grounds of cost.

But in fact, when compared to the possible economic burden linked to respiratory adverse events, capnography is overall cost-effective – with one study quantifying a saving of €55 per 100 patients.([FOOTNOTE=Bisschops R, Saunders R, Dooms C, Hoffman I, van der Merwe S, Weissbrod R, Torres RT, Van Assche G, Demedts I. Implementing capnography to help improve patient safety during procedural sedation: quality improvement in a high-volume gastroenterology department. Eur J Gastroenterol Hepatol. 2021 Apr 19. doi: 10.1097/MEG.0000000000002144. Epub ahead of print. PMID: 33905213.],[ANCHOR=],[LINK=])

WHAT 3 SOLUTIONS ARE AVAILABLE?

1. Microstream™ Capnography

Discover our complete capnography portfolio enabling clinicians to accurately([FOOTNOTE=Maddox RR, Williams CK, Oglesby H, Butler B, Colclasure B. Clinical experience with patient-controlled analgesia using continuous respiratory monitoring and a smart infusion system. Am J Health Syst Pharm. 2006 Jan 15;63(2):157-64. doi: 10.2146/ajhp050194. PMID: 16390930.],[ANCHOR=],[LINK=]) monitor patients during procedural sedation.

CAPNOGRAPHY CAN HELP YOU TO REDUCE THESE RESPIRATORY RELATED EVENTS

The Microstream™ capnography portfolio includes bedside monitors that are easy to use, designed for both intubated and non-intubated patients, and come with a complete portfolio of single-use sampling lines.

2. Educational Package

A comprehensive offering of remote and live educational opportunities including interactive decks, e-learning modules, clinical documents, webinars, podcast series, masterclasses and on-site support helping you and your team to:

  • Learn about capnography from the basics to waveforms interpretation
  • Apply procedural sedation using different approaches
  • Recognise complications during procedural sedation
  • Judge on the value of various monitoring technologies
  • Recognise the additional value of capnography during sedation

3. Outcomes pledge program

The Medtronic Outcomes Pledge Program is designed to help hospitals enhance patient care, help improve overall outcomes, and help reduce operating costs. The flexible programme offers a choice of options (outlined below), structured to help improve clinical outcomes supported by clinically relevant metrics.

HOW THE OUTCOMES PLEDGE WORKS:

IDENTIFY YOUR TARGET

Adult patients undergoing moderate to deep procedural sedation, not currently using continuous capnography monitoring in Gastrointestinal Endoscopy, Interventional Cardiology and Interventional Radiology.

MEASURE YOUR BASELINE

Measure baseline incidence of respiratory adverse events & interventions with a specialised data collection tool for use by clinical staff.

AGREE ON THE PLEDGE

Set the target % reduction of respiratory adverse events.

IMPLEMENT CAPNOGRAPHY 

Measure incidence of respiratory adverse events & interventions with capnography and continue to use the specialised data collection tool.

Would you like to optimize your patients' monitoring during procedural sedation?

Contact us to learn more about the solutions Medtronic has available: we can help you understand the positive impact that effective capnography monitoring could have on your organisation, and the patients you care for.