Patient Safety

Capnography use associated with reduction of adverse outcomes during procedural sedation Continuous Patient Monitoring Reduces Likelihood of Adverse Events and Patient Deaths

Millions of gastrointestinal endoscopy are performed each year in the US, with colonoscopies making up the majority of such procedures. Research conducted by Michael W. Jopling, MD and Qiu Jiejing published in BMC Anesthesiology concluded that capnography use associated with reduction of adverse outcomes during procedural sedation.

Their research sought to “estimate the incidence of pharmacological rescue events and death at discharge from an inpatient or outpatient hospitalization where [gastrointestinal endoscopic procedures] GEP was performed with sedation, and to determine if capnography monitoring was associated with reduced incidence of these adverse outcomes.”

Retrospective Analysis of the Premier Database
Patient Being Monitored with Capnography

Patient Being Monitored with Capnography

Dr. Jopling and Ms. Qiu did a retrospective analysis of the Premier Database, which can be best described as:

“a large, U.S. hospital-based, service-level, all-payer database that contains information on inpatient discharges, primarily from geographically diverse non-profit, nongovernmental and community and teaching hospitals and health systems from rural and urban areas. Hospitals/healthcare systems submit administrative, healthcare utilization and financial data from patient encounters. Inpatient admissions include over 80 million visits with more than 5 million per year since 2011, representing approximately twenty percent of annual United States inpatient discharges. Outpatient encounters include over 550 million outpatient visits, with more than 34 million visits per year since 2011. Outpatient visits to emergency departments, ambulatory surgery centers and alternate sites of care are captured for the primary diagnosis. The PHD contains data from over 147 million unique patients.”

Analyzing the Premier Database, Dr. Jopling and Ms. Qiu looked at 258,000, 262,000 inpatients and 3,807,151 outpatients events. Patients undergoing  (GEP) were grouped by how they are monitored electronically:

  • pulse oximetry (SpO2) only
  • capnography only
  • SpO2 with capnography
  • neither SpO2 nor capnography.
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Capnography Monitoring Associated with Reduction in Adverse Events

Their analysis found the following results:

“For inpatients, capnography monitoring was associated with a 47% estimated reduction in the odds of death at discharge (OR: 0.53 [95% CI: 0.40–0.70]; P < 0.0001) and a non-significant 10% estimated reduction in the odds of pharmacological rescue event at discharge (0.91 [0.65–1.3]; P = 0.5661). For outpatients, capnography monitoring was associated with a 61% estimated reduction in the odds of pharmacological rescue event at discharge (0.39 [0.29, 0.52]; P < 0.0001) and a non-significant 82% estimated reduction in the odds of death at discharge (0.18 [0.02, 1.99]; P = 0.16).”

Based on these results, Dr. Jopling and Ms. Qiu concluded:

“In hospital medical inpatients and all outpatients undergoing GEP performed with sedation, capnography monitoring was associated with a reduced likelihood of pharmacological rescue events in outpatients and death in inpatients when assessed at discharge. Despite the limitations of the retrospective data analysis methodology, the use of capnography during these procedures is recommended.” [emphasis added]

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PPAHS Clinical Education Podcast with Dr. Michael Jopling

The Physician-Patient Alliance for Health & Safety (PPAHS) will be interviewing the lead author Dr. Jopling. This clinical education podcast will be made available on the PPAHS YouTube Channel.

Please subscribe to PPAHS YouTube Channel to receive notification of the podcast with Dr. Jopling and other clinicians and patient safety experts.

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