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.
To help you understand the advice, Medtronic has produced an eBook on Clinical Society Guidelines for Capnography Monitoring, enabling you to:
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=])
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.
Adult patients undergoing moderate to deep procedural sedation, not currently using continuous capnography monitoring in Gastrointestinal Endoscopy, Interventional Cardiology and Interventional Radiology.
Measure baseline incidence of respiratory adverse events & interventions with a specialised data collection tool for use by clinical staff.
Set the target % reduction of respiratory adverse events.
Measure incidence of respiratory adverse events & interventions with capnography and continue to use the specialised data collection tool.