title: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT. Electronic address: Melissa.Langhan@Yale.edu.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Langhan
authors.affiliation: Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, CT.
authors.forename: Veronika
authors.initials: V
authors.lastname: Shabanova
authors.affiliation: Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, CT.
authors.forename: Fang-Yong
authors.initials: FY
authors.lastname: Li
authors.affiliation: Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Bernstein
authors.affiliation: Department of Pediatrics, Yale University School of Medicine, New Haven, CT; School of Medicine and Department of Investigative Medicine, Graduate School of Arts and Sciences, Yale University School of Medicine, New Haven, CT.
authors.forename: Eugene D
authors.initials: ED
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D019296:Capnography / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007040:Hypoventilation / Q000517:prevention & control; D007223:Infant; D008297:Male; D055815:Young Adult