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Does End‐tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices?
Author(s) -
Burton John H.,
Harrah John D.,
Germann Carl A.,
Dillon Douglas C.
Publication year - 2006
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2005.12.017
Subject(s) - medicine , hypoventilation , anesthesia , sedation , respiratory monitoring , capnography , apnea , emergency department , ventilation (architecture) , airway , respiratory system , oxygen saturation , intensive care medicine , oxygen , psychiatry , engineering , mechanical engineering , chemistry , organic chemistry
Objectives:The value of ventilation monitoring with end‐tidal carbon dioxide (ETCO 2 ) to anticipate acute respiratory events during emergency department (ED) procedural sedation and analgesia (PSA) is unclear. The authors sought to determine if ETCO 2 monitoring would reveal findings indicating an acute respiratory event earlier than indicated by current monitoring practices.Methods:The study included a prospective convenience sample of ED patients undergoing PSA. Clinicians performed ED PSA procedures with generally accepted patient monitoring, including oxygen saturation (SpO 2 ), and clinical ventilation assessment. A study investigator recorded ETCO 2 levels and respiratory events during each PSA procedure, with clinical providers blinded to ETCO 2 levels. Acute respiratory events were defined as SpO 2 ≤92%, increases in the amount of supplemental oxygen provided, use of bag‐valve mask or oral/nasal airway for ventilatory assistance, repositioning or airway alignment maneuvers, and use of physical or verbal means to stimulate patients with depressed ventilation or apnea, and reversal agent administration.Results:Enrollment was stopped after independent review of 20 acute respiratory events in 60 patient sedation encounters (33%). Abnormal ETCO 2 findings were documented in 36 patients (60%). Seventeen patients (85%) with acute respiratory events demonstrated ETCO 2 findings indicative of hypoventilation or apnea during PSA. Abnormal ETCO 2 findings were documented before changes in SpO 2 or clinically observed hypoventilation in 14 patients (70%) with acute respiratory events.Conclusions:Abnormal ETCO 2 findings were observed with many acute respiratory events. A majority of patients with acute respiratory events had ETCO 2 abnormalities that occurred before oxygen desaturation or observed hypoventilation.