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Respiratory depression detected by capnography among children in the postanesthesia care unit: a cross-sectional
Melissa L Langhan1, Fang-Yong Li2, J Lance Lichtor3
1Department of Pediatrics and Emergency Medicine, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
Insights
Capnography monitoring revealed that nearly half of children in the postanesthesia care unit (PACU) experienced hypoventilation or apnea. Routine capnography use could improve patient safety by detecting respiratory depression.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Respiratory Physiology
Background:
- Children are susceptible to respiratory depression post-anesthesia.
- Current postanesthesia care unit (PACU) monitoring with pulse oximetry has limitations in detecting hypoventilation or apnea, especially with supplemental oxygen.
- Capnography, a sensitive ventilation monitor, is underutilized in the PACU.
Purpose of the Study:
- To assess the incidence of hypoventilation and apnea in pediatric PACU patients using capnography.
- To compare capnography findings with pulse oximetry and recorded interventions.
Main Methods:
- A cross-sectional study involving 194 healthy children (age 1-17 years) in a tertiary care hospital PACU.
- Capnography was used for monitoring, with staff blinded to its readings and alarms disabled.
- Routine care, pulse oximetry, vital signs, and interventions were recorded.
Main Results:
- Capnography detected hypoventilation or apnea in 45.5% of children.
- Oxygen desaturations occurred in 19% of patients, with interventions in 9%.
- Narcotic use increased the likelihood of hypoventilation and apnea; supplemental oxygen was associated with more hypoventilation.
Conclusions:
- Hypoventilation and apnea are frequent in pediatric PACU patients, often without intervention.
- Implementing routine capnography monitoring may enhance the recognition of respiratory depression and improve PACU patient safety.
Background:
Children are at risk for respiratory depression while recovering from anesthesia. Currently, monitoring children in the postanesthesia care unit (PACU) with pulse oximetry is recommended. However, pulse oximetry does not reliably recognize hypoventilation or apnea, particularly in the presence of supplemental oxygen. Capnography is a sensitive monitor of ventilation that is not often used in the PACU.
Aim:
To determine the frequency of hypoventilation and apnea as detected by capnography among children in the PACU.
Methods:
In a cross-sectional study, capnography monitoring was applied to healthy children of age 1-17 years in the PACU of a tertiary care hospital. Staff was blinded to the capnography monitor; alarms were disabled. Staff provided routine care and monitoring with pulse oximetry to all patients. Vital signs, patient interventions, and medication administration were recorded by a research assistant every 30 s until all monitoring was discontinued by staff. Outcome measures included frequency of hypoventilation and apnea as measured by capnography and oxygen desaturations as measured by pulse oximetry, as well as staff interventions for these events.
Results:
Data from 194 children were analyzed. Capnography detected hypoventilation or apnea in 45.5% (95% CI 38.5%, 52.5%) of patients. Oxygen desaturations occurred in 19% (95% CI 13%, 24%) of patients. Interventions occurred in 9% (95% CI 5%, 13%) of patients. Patients who received narcotic medications were more likely to experience hypoventilation (OR 2.3, 95% CI 1.02, 5.3) and apnea (OR 2.7, 95% CI 1.1, 7). Hypoventilation was seen more often among children who received supplemental oxygen (OR 3.1, 95% CI 1.1, 12).
Conclusions:
Hypoventilation and apnea are common among children in the PACU; however, few interventions occur to address these events. Routine monitoring with capnography may improve recognition of respiratory depression and enhance patient safety in the PACU.
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