#EMconf: Capnography for Procedural Sedation

Does Capnography for Procedural Sedation Reduce Hypoxic Events?

Bottom Line:
- According to Study 1, there are less hypoxic events using capnography
- If there are signs of respiratory depression on capnography, hypoxia may occur during procedural sedation and providers are more likely to do non-invasive airway repositioning (jaw thrust)

Study 1:
● Double-blinded, prospective, RCT in urban academic center ED hypothesizing that capnography decreases hypoxic events in procedural sedation
● There was statistically more hypoxic events in procedural sedation with standard monitoring (42%) than in capnography + standard monitoring group (25%), p-value < 0.035
● Capnography had a sensitivity of 100% and specificity of 64% for hypoxia
● Concluded capnography reduces hypoxic events in propofol procedural sedation in ED

Study 2:
● Non-blinded, prospective, RCT in ED of trauma center in Nova Scotia with objective of analyzing the utility of capnography in procedural sedation
● Concluded no difference in hypoxia events in capnography group vs. standard monitoring but more hypotensive events in capnography group (1.4% v. 1.9%, p-value < 0.569); this study did have patients with more comorbidities in capnography arm
● More “airway repositioning” (jaw thrust) in capnography group (26.2%) compared to control group (18.4%), p-value < 0.003
● Concluded no difference in hypoxia, more hypotension, more airway maneuvers with capnography