bwge2019

Authors
R. BISSCHOPS (1), I. DEMEDTS (1), P. ROELANDT (1), C. DOOMS (2), I. HOFMAN (3), R. WEISSBROD (4), R. SAUNDERS (5), M. HIELE (1), G. VAN ASSCHE (1) / [1] University Hospitals Leuven, , Belgium, Gastroenterology and Hepatology, [2] University Hospitals Leuven, , Belgium, Pneumology, [3] University Hospitals Leuven, , Belgium, Pediatrics, [4] Medtronic, Jerusalem, Israel, R&D, [5] Coreva Scientific, Freiburg, Germany, Health economics
Introduction
Respiratory compromise (RC) is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure, respiratory arrest or death, but in which specific interventions (continuous monitoring and therapies) might prevent or mitigate decompensation. RC is the main cause of adverse events (AEs) occurring during procedural sedation. However, many clinicians are not aware of the incidence, the potential clinical consequences, and the value of monitoring in preventing AEs.
Aim
The study evaluated the incidence of respiratory-related AEs and interventions occurring during procedural sedation using World SIVA task force consensus definitions and the impact of capnography monitoring on these.
Methods
Our study was designed as a before-after quality improvement evaluation that received an ethics committee waiver. We compared data for patients admitted for scheduled procedures performed in the department with standard of care monitoring (control) to the data gathered for patients sequentially admitted for scheduled procedures that were monitored after full training with capnography both during the procedure and in recovery (intervention). Events were recorded during both the procedure and the recovery period. Collected data were deidentified and aggregated and included the ASA risk score, type of procedure, procedure duration, clinician ID and any indicated SIVA defined AEs and interventions that occurred. Incidence rates and relative risks for events and interventions were determined. The primary quality improvement endpoint was the change in total incidence of mild oxygen desaturation, severe oxygen desaturation, bradycardia, and tachycardia with capnography monitoring.
Results
Data were gathered between February 2018-June 2018, with 1,092 control patients and 1,044 intervention patients. In the control group there were on average 11.45 AEs per 100 procedures. In the intervention group there were on average 5.08 AEs per 100 procedures. The absolute difference between arms was -6.37 (95% [CI], -8.7 to -4.1) AEs per 100 procedures representing a 55.69% reduction (p=0.0001). The RR for a patient experiencing the primary outcome with use of capnography was: 0.43 (95% CI, 0.31 to 0.58). Nine escalations of care were reported in the control group with none reported in the intervention group. The relative risks of experiencing both AEs and interventions during recovery were reduced significantly in the capnography arm with a RR of 0.17 and 0.15, respectively for risk of AEs and need for intervention.
Conclusions
Capnography significantly reduced the incidence of respiratory AEs in real life use at a university hospital GI procedure suite.