Capnography for procedural sedation in the ED: a systematic review

Area of Science:

• Emergency Medicine
• Critical Care
• Anesthesiology

Background:

• Procedural sedation and analgesia (PSA) is frequently performed in the Emergency Department (ED).
• Capnography is recognized as a sensitive indicator of respiratory depression during PSA.
• This review evaluates capnography's impact on patient safety during adult PSA in the ED.

Purpose of the Study:

• To systematically review the literature on capnography use during PSA in the ED.
• To assess the diagnostic accuracy of capnography in identifying adverse events.
• To determine if capnography provides additional patient safety benefits compared to standard monitoring.

Main Methods:

• Systematic literature search of multiple databases (MEDLINE, Embase, Scopus, CINAHL, Google Scholar).
• Data extraction by two independent reviewers.
• Meta-analysis using random-effects model to assess diagnostic accuracy and heterogeneity.

Main Results:

• Seven studies with 662 patients were included.
• Capnography showed moderate diagnostic accuracy for adverse events (Sensitivity: 0.82, Specificity: 0.6).
• No statistically significant difference in adverse event detection was found between capnography plus standard monitoring and standard monitoring alone.

Conclusions:

• Current evidence does not support capnography providing additional safety during adult PSA in the ED.
• Limited research exists on preoxygenated patients on high-flow oxygen during PSA.
• High-quality randomized controlled trials are needed; adherence to current recommendations for capnography use is advised.