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hypoxia, based on the changes noted in the EtCO2 values prior to each hypoxic event (Deitch, et al., 2010; Waugh, Epps, & Khodneva, 2011). Studies also denote that vital signs and depth of sedation assessment by clinicians were not able to detect hypoventilation early enough to preventhypoxic events, which were noted to be concerning (Deitch, et al., 2010; Waugh, Epps, & Khodneva, 2011). Literature denotes a direct association between desaturation measured via pulse-oximetry and poor patient outcomes (Lightdale, Feldman, & DiNardo, 2006). Consequently, using capnography in procedural sedation can afford the ED physician a warning pertaining to ventilatory compromise to prevent or reduce hypoxic occurrences, thus improving patient safety and outcomes related to procedural sedation. Some gaps in literature were noted during the course of the literature review, which would constitute as recommendation for future research. Studies indicated select patients signified changes in EtCO2 levels, but did not progress onto developing hypoxia (Burton, et al., 2006; Deitch, et al., 2010). Accordingly, it would be worthwhile to examine the specificity of the capnographic variations that would be most indicative of progressing onto hypoxia. Further, it would also be interesting to assess the median time difference from the incidence of hypoventilation to the manifestation of hypoxia, which would signify the average time the physician has to intervene prior to the adverse event. Additionally, current literature is also inconclusive related to the impact of pre-oxygenation on sedation-related hypoxia. Studies pertaining to this topic may produce further information on sedation-related hypoxia.
EVIDENCE-BASED PRACTICE PROPOSAL FINAL PAPER35ConclusionClinicians without anesthesia training are progressively called upon to execute proceduralsedation in the ED. The standard modalities of monitoring patients undergoing procedural sedation are inefficient at sensing hypoventilation early, with high frequency of patients progressing to hypoxemia. Capnography has been indicated to detect hypoventilation proficiently. This study is projected to present information on capnography for use in proceduralsedation in the ED, applying an evidence-based approach. The expected outcome would be a conspicuous reduction in occurrences of hypoventilation, apnea, and hypoxia during procedural sedation in the ED, thus reducing negative patient outcomes, and improving patient safety. Evidence generated from the pilot study could be transferred to other areas that utilize proceduralsedation, such as other emergency departments, endoscopy suites, and cardiac catheterization suites.Reference
EVIDENCE-BASED PRACTICE PROPOSAL FINAL PAPER36American College of Emergency Physicians. (2005). Clinical policy: Procedural sedation and analgesia in the emergency department. Annals of Emergency Medicine, 45:177-196.