Summary of findings for the main comparison. Capnography and standard monitoring compared with standard monitoring for emergency department patients undergoing procedural sedation and analgesia.
| Capnography and standard monitoring compared with standard monitoring for emergency department patients undergoing procedural sedation and analgesia | ||||||
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Patient or population: patients undergoing PSA Settings: emergency departments in North America Intervention: capnography and standard monitoring Comparison: standard monitoring | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Standard monitoring | Capnography and standard monitoring | |||||
| Oxygen desaturation | Medium risk population | RR 0.89 (0.48 to 1.63) | 1272 participants (3 studies) | ⊕⊕⊕⊝ Moderateb | ‐ | |
| 8 per 1000a | 7 per 1000 (4 to 13) | |||||
| Hypotension | Medium risk population | RR 2.36 (0.98 to 5.69) | 986 participants (1 study) | ⊕⊕⊕⊝ Moderated | ‐ | |
| 6 per 1000c | 14 per 1000 (6 to 34) | |||||
| Emesis, pulmonary aspiration | Medium risk population | RR 3.10 (0.13 to 75.88) | 986 participants (1 study) | ⊕⊕⊕⊝ Moderated | None of the studies recorded pulmonary aspiration events. | |
| 4 per 1000e |
4 per 1000 (1 to 304) |
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| Airway interventions | Medium risk population | RR 1.26 (0.94 to 1.69) | 1272 participants (3 studies) | ⊕⊕⊕⊝ Moderateg | 2 studies included verbal/physical stimulation and supplemental oxygen as airway interventions (not consistent with our definition) but only reported total airway interventions (as dichotomous outcomes). | |
| 150 per 1000f | 189 per 1000 (141 to 254) | |||||
| Airway interventions adult subgroup analysis (aged ≥ 18 years)h | Medium risk population | RR 1.44 (1.16 to 1.79) | 1118 participants (2 studies) | ⊕⊕⊕⊝ Moderatej | ‐ | |
| 190 per 1000i | 274 per 1000 (220 to 340) | |||||
| Recovery time | None of the studies reported recovery time. | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; PSA: procedural sedation and analgesia; RR: risk ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aCampbell 2006; Cudny 2013. No study found to determine assumed risk for all‐age population, combined incidence of these studies used as a surrogate. Hypoxia defined as oxygen saturation < 90% at any time with baseline oxygen saturation ≥ 95% for Campbell 2006. Unknown definition of hypoxia for Cudny 2013.
b Although statistics show low to moderate heterogeneity (I2 = 42%, P = 0.18), quality downgraded due to heterogeneity in study designs.
cCampbell 2006. Hypotension defined as systolic blood pressure < 85 mmHg at any time with baseline systolic blood pressure ≥ 100 mmHg.
d Downgraded for reporting bias in one study.
eLanghan 2012. Used this paediatric study as surrogate for all ages population.
g Downgraded due to significant heterogeneity (I2 = 53%).
h The study by Campbell 2016 reported adults aged 16 years or greater whereas the study by Deitch 2010 reported adults aged greater than 18 years.
j Downgraded due to heterogeneity in outcome definitions as well as small number of studies.