A randomized controlled trial of capnography during sedation in a pediatric emergency setting

Abstract

Objective: Data suggest that capnography is a more sensitive measure of ventilation than standard modalities and detects respiratory depression before hypoxemia occurs. We sought to determine if adding capnography to standard monitoring during sedation of children increased the frequency of interventions for hypoventilation, and whether these interventions would decrease the frequency of oxygen desaturations.

Methods: We enrolled 154 children receiving procedural sedation in a pediatric emergency department. All subjects received standard monitoring and capnography, but were randomized to whether staff could view the capnography monitor (intervention) or were blinded to it (controls). Primary outcome were the rate of interventions provided by staff for hypoventilation and the rate of oxygen desaturation less than 95%.

Results: Seventy-seven children were randomized to each group. Forty-five percent had at least 1 episode of hypoventilation. The rate of hypoventilation per minute was significantly higher among controls (7.1% vs 1.0%, P = .008). There were significantly fewer interventions in the intervention group than in the control group (odds ratio, 0.25; 95% confidence interval [CI], 0.13-0.50). Interventions were more likely to occur contemporaneously with hypoventilation in the intervention group (2.26; 95% CI, 1.34-3.81). Interventions not in time with hypoventilation were associated with higher odds of oxygen desaturation less than 95% (odds ratio, 5.31; 95% CI, 2.76-10.22).

Conclusion: Hypoventilation is common during sedation of pediatric emergency department patients. This can be difficult to detect by current monitoring methods other than capnography. Providers with access to capnography provided fewer but more timely interventions for hypoventilation. This led to fewer episodes of hypoventilation and of oxygen desaturation.

Trial registration: ClinicalTrials.gov NCT01463527.

Figure 1

Proportion of subjects with hypoventilation during every 30-second interval of the sedation in the control and intervention groups.

Figure 2

Proportion of subjects receiving an intervention in each 30-second interval of the sedation in the control and intervention groups.

Figure 3

Proportion of subjects experiencing an oxygen desaturation <95% in every 30-second interval during the sedation based on timely and delayed interventions.

Figure A.1

Proportion of subjects with persistent hypoventilation during every 30-second interval of the sedation in the control and intervention groups.

Figure A.2

Proportion of subjects receiving an appropriately timed intervention in each 30- second interval of the sedation in the control and intervention groups.

Figure A.3

Proportion of subjects experiencing an oxygen desaturation <95% in every 30 second interval during the sedation in the control and intervention groups.