Aims:
As part of a quality-improvement initiative in a high-volume university hospital GI
department, the study evaluated the incidence of respiratory-related adverse events
(AEs) and interventions occurring during sedation using World SIVA task force consensus
definitions and the impact of capnography monitoring on these.
Methods:
We compared data for patients admitted for scheduled procedures performed in the department
with standard of care monitoring (control) to the data gathered for patients sequentially
admitted for scheduled procedures that were monitored after full training with capnography
both during the procedure and in recovery (intervention). Events were recorded during
both the procedure and the recovery period. Collected data included the ASA risk score,
type of procedure, procedure duration, clinician ID and any indicated SIVA defined
AEs and interventions that occurred. Incidence rates and relative risks for events
and interventions were determined. The primary quality improvement endpoint was the
change in total incidence of mild oxygen desaturation, severe oxygen desaturation,
bradycardia, and tachycardia with capnography monitoring.
Results:
Between February 2018-June 2018, 1,092 control and 1,044 intervention patients were
included. In the control group there were on average 11.45 AEs per 100 procedures.
In the intervention group there were on average 5.08 AEs per 100 procedures. The absolute
difference between arms was -6.37 (95% [CI], -8.7 to -4.1) AEs per 100 procedures
representing a 55.69% reduction (p = 0.0001). The RR for a patient experiencing the
primary outcome with use of capnography was: 0.43 (95% CI, 0.31 to 0.58). Nine escalations
of care were reported in the control group with none reported in the intervention
group. The relative risks of experiencing both AEs and interventions during recovery
were reduced significantly in the capnography arm (0.17 and 0.15, respectively).
Conclusions:
Capnography significantly reduced the incidence of respiratory AEs in real life use
at a university hospital GI procedure suite.
