Capnography versus standard monitoring for emergency department procedural sedation and analgesia

Brian F Wall; Kirk Magee; Samuel G Campbell; Peter J Zed

doi:10.1002/14651858.CD010698.pub2

Kapnografi berbanding pemantauan standard untuk prosedur bius dan analgesia jabatan kecemasan

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Referencias

References to studies included in this review

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estudios excluidos
otras referencias
otras versiones publicadas

Campbell SG, Magee KD, Zed PJ, Froese P, Etsell G, LaPierre A, et al. End‐tidal capnometry during emergency department procedural sedation and analgesia: a randomized trial. World Journal of Emergency Medicine 2016;7(1):13‐8. [PUBMED: 27006732]

Deitch K, Miner J, Chudnofsky CR, Dominici P, Latta D. Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial. Annals of Emergency Medicine 2010;5(3):258‐64. [DOI: 10.1016/j.annemergmed.2009.07.030; PUBMED: 19783324]

Langhan ML, Shabanova V, Li FY, Bernstein SL, Shapiro ED. A randomized controlled trial of capnography during sedation in a pediatric emergency setting. American Journal of Emergency Medicine 2015;33(1):25‐30. [PUBMED: 25445871]

References to studies excluded from this review

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estudios incluidos
otras referencias
otras versiones publicadas

Deitch K, Chudnofsky CR, Dominici P. The utility of supplemental oxygen during emergency department procedural sedation and analgesia with midazolam and fentanyl: a randomized, controlled trial. Annals of Emergency Medicine 2007;49(1):1‐8. [PUBMED: 16978741]

Deitch K, Chudnofsky CR, Dominici P. The utility of supplemental oxygen during emergency department procedural sedation with propofol: a randomized, controlled trial. Annals of Emergency Medicine 2008;52(1):1‐8. [PUBMED: 18294729]

Hart LS, Berns SD, Houck CS, Boenning DA. The value of end‐tidal CO2 monitoring when comparing three methods of conscious sedation for children undergoing painful procedures in the emergency department. Pediatric Emergency Care 1997;13(3):189‐93. [PUBMED: 9220504]

Sivilotti MLA, Messenger DW, Van Vlymen J, Dungey PE, Murray HE. A comparative evaluation of capnometry versus pulse oximetry during procedural sedation and analgesia on room air. Canadian Journal of Emergency Medicine 2010;12(5):397‐404. [PUBMED: 20880431]

Additional references

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Anderson JL, Junkins E, Pribble C, Guenther E. Capnography and depth of sedation during propofol sedation in children. Annals of Emergency Medicine 2007;49:9‐13.

Burton JH, Harrah JD, Germann CA, Dillon DC. Does end‐tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?. Academic Emergency Medicine 2006;13(5):500‐4.

Burton F. Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 2: should capnography be routinely used during procedural sedation in the emergency department?. Emergency Medicine Journal 2012;29:164‐6.

Campbell SG, Magee KD, Kovacs GJ, Petrie DA, Tallon JM, McKinley R, et al. Procedural sedation and analgesia in a Canadian adult tertiary care emergency department: a case series. Canadian Journal of Emergency Medicine 2006;8(2):85‐93.

Cudny M, Wang N, Bardas S, Nguyen C. Adverse events associated with procedural sedation in pediatric patients in the emergency department. Hospital Pharmacy 2013;48(2):134‐42.

Egger M, Smith GD, Phillips AN. Meta‐analysis: principles and procedures. BMJ 1997;315:1533‐7.

Thomson Reuters. EndNote X7.4. Thomson Reuters, 2015.

Godwin SA, Caro DA, Wolf SJ, Jagoda AS, Charles R, Marett BE, et al. American College of Emergency Physicians. Clinical policy: procedural sedation and analgesia in the emergency department. Annals of Emergency Medicine 2005;45:177‐96.

Godwin S, Burton J, Gerardo C, Hatten B, Mace S, Silvers S, et al. Clinical Policy: Procedural Sedation and Analgesia in the Emergency Department. Annals of Emergency Medicine 2014;63:247‐58.

Green SM, Pershad J. Should capnographic monitoring be standard practice during emergency department procedural sedation and analgesia? Pro and con. Annals of Emergency Medicine 2010;55:265‐7.

Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck‐Ytter Y, Schunemann HJ. What is "quality of evidence" and why is it important to clinicians. BMJ 2008;336:995‐8. [PUBMED: 18456631]

Higgins JPT, Green S, editor(s). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from handbook.cochrane.org.

Kodali BS. Capnography outside the operating rooms. Anesthesiology 2013;118:192‐201.

Krauss B, Hess DR. Capnography for procedural sedation and analgesia in the emergency department. Annals of Emergency Medicine 2007;50:172‐81. [PUBMED: 17222941 ]

Langhan ML, Mallory M, Hertzog J, Lowrie L, Cravero J. Physiologic monitoring practices during pediatric procedural sedation. A report from the Pediatric Sedation Research Consortium. Archives of Pediatrics & Adolescent Medicine 2012;166:990‐8.

Mallory MD, Baxter AL, Yanosky DJ, Cravero JP. Emergency physician administered propofol sedation: a report on 25,433 sedations from the Pediatric Sedation Research Consortium. Annals of Emergency Medicine 2011;57:462‐8.

McCarney R, Warner J, Iliffe S, van Haselen R, Griffin M, Fisher P. The Hawthorne Effect: a randomised, controlled trial. BMC Medical Research Methodology 2007;7(30):1‐8.

Miner JR, Heegaard W, Plummer D. End‐tidal carbon dioxide monitoring during procedural sedation. Academic Emergency Medicine 2002;9:275‐80.

Miner JR, Biros M, Krieg S, Johnson C, Heegaard W, Plummer D. Randomized clinical trial of propofol versus methohexital for procedural sedation in the emergency department. Academic Emergency Medicine 2003;10:931‐7.

Mohr NM, Wessman B. Routine capnography in procedural sedation. Annals of Emergency Medicine 2013;61:697‐8.

The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

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Swanson E, Seaberg DC, Mathias S. The use of propofol for sedation in the emergency department. Academic Emergency Medicine 1996;3:234‐8.

Wright SW. Conscious sedation in the emergency department: the value of capnography and pulse oximetry. Annals of Emergency Medicine 1992;21:551‐5.

References to other published versions of this review

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estudios incluidos
estudios excluidos
otras referencias

Wall BF, Magee K, Campbell SG, Zed PJ. Capnography versus standard monitoring for emergency department procedural sedation and analgesia. Cochrane Database of Systematic Reviews 2013, Issue 8. [DOI: 10.1002/14651858.CD010698]

Characteristics of studies

Characteristics of included studies [ordered by study ID]

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estudios excluidos

Campbell 2016

Methods	Design: prospective, RCT Blinding: research associates blinded, participants and personnel unblinded, allocation concealed Dates: April 2006 to April 2010
Participants	n = 986 Included: adults (aged > 16 years) requiring PSA Excluded: critically ill people or people unable to give consent Location: emergency department, tertiary care university hospital, Canada
Interventions	Control (n = 501) Standard monitoring (cardiac monitoring, blood pressure monitoring, pulse oximetry) Intervention (n = 485) Standard monitoring (as above) and end‐tidal capnography (measured every 5 seconds or absence of waveform at any time)
Outcomes	Primary Oxygen desaturation (< 90% SpO₂ for > 30 seconds) Airway interventions (airway repositioning manoeuvre, positive pressure ventilation, oral/nasal airway placement, endotracheal intubation)* Secondary Hypotension (SBP < 100 mmHg or < 85 mmHg if baseline < 100 mmHg) Sedation time (time from first dose of drug administration to commencement of procedure Recovery time (time from end of procedure to cessation of monitoring) Vomiting
Funding sources	Research grant from government organization (Capital Health Research Fund, Halifax, Nova Scotia, Canada)
Declarations of interest	No authors declared any actual or potential conflicts of interest.
Notes	* Published data for airway interventions was continuous. Dichotomous data obtained by contacting authors.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomly assigned to each group by research associates (blinded) using computer‐generated randomization.
Allocation concealment (selection bias)	Low risk	Allocation concealed using opaque white envelopes.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unblinded participants and personnel.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Unblinded outcome assessment.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No data excluded, all data included in analysis.
Selective reporting (reporting bias)	Unclear risk	All participants accounted for. Study was not enrolled in a trial registry and thus modifications to the study methods could not be assessed.
Other bias	Low risk	Funding: supported by an independent government grant.

Deitch 2010

Methods	Design: prospective RCT Blinding: research associates blinded, participants and personnel unblinded, allocation concealed Dates: November 2006 to February 2008
Participants	n = 132 Included: adults (aged > 18 years) requiring PSA Excluded: severe chronic obstructive pulmonary disease; chronic oxygen requirements; haemodynamic instability; respiratory distress; pregnancy; inability to provide informed consent; allergy to propofol, morphine, or fentanyl (or other components of its formulation); or if, in the judgement of the attending emergency physician, procedural sedation could compromise participant safety; critically ill patients or patients unable to give consent Location: emergency department, tertiary care university hospital, US
Interventions	Control (n = 64) Standard monitoring (cardiac monitoring, pulse oximetry, and blood pressure monitoring) and blinded capnography Intervention (n = 68) Standard monitoring and capnography (measured every 5 seconds with waveform, respiratory depression defined as > 50 mmHg, absolute increase or decrease from baseline of > 10%, or loss of waveform for > 15 seconds)*
Outcomes	Primary Hypoxia defined as < 93% SpO₂ for > 15 seconds Secondary Airway Interventions (verbal or physical stimulation; airway realignment; use of additional oxygen; and use of airway adjuncts, assisted ventilation, or intubation) Hypotension (undefined, not reported in results) Vomiting (not reported in results)
Funding sources	Capnography equipment donated by private company (Oridian Medical, Needham, MA)
Declarations of interest	No authors declared any actual or potential conflicts of interest
Notes	* Disqualified graphs if > 35% data loss
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Randomly assigned to each group by research associates (blinded) using a computer‐generated randomization list.
Allocation concealment (selection bias)	Low risk	Research associates and treating physicians were blinded to the randomization choice until after enrolment.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Although all participants had capnography, only the participants/personnel in the capnography group could see the capnography monitor, whereas the standard group knew that they could not see the capnography monitor. Therefore, this was not blinded.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Investigators evaluating graphs for outcome measures were blinded.
Incomplete outcome data (attrition bias) All outcomes	High risk	Participant data excluded if 35% data loss. This resulted in 18/150 (12%) participants excluded.
Selective reporting (reporting bias)	High risk	Primary outcome data all accounted for outside the above exclusions. Secondary outcomes listed including vomiting and hypotension were mentioned in methods section but not reported on in results. The specific airway interventions were not reported (only total number of interventions) despite the methods section stating these data were collected.
Other bias	Unclear risk	Oxygen desaturation outcome defined as SpO2 < 93%. We were unable to reach author for unpublished data regarding this outcome. Funding: a device performing capnography was donated by a private medical manufacturing company.

Langhan 2015

Methods	Design: prospective RCT Blinding: research associates unblinded, participants and personnel unblinded, allocation concealed Dates: September 2011 to January 2013.
Participants	n = 154 Included: paediatric participants (aged 1 to 20 years) requiring PSA Excluded: intubation, administration of baseline supplemental oxygen without preceding hypoxaemia, and conditions associated with abnormal ETCO₂ values such as lower airway disease (e.g. asthma), diabetic ketoacidosis, moderate to severe dehydration, and major trauma. Participants were excluded if they did not tolerate the capnography cannula or if the participant cried for > 20% of the sedation Location: paediatric emergency department, tertiary care university hospital, US
Interventions	Control (n = 77) Standard monitoring (cardiac monitoring, pulse oximetry, and blood pressure monitoring) and blinded capnography Intervention (n = 77) Standard monitoring and capnography (alerts at ETCO₂ levels of < 30 mmHg and > 50 mmHg)
Outcomes	Primary Oxygen desaturation (SpO₂ < 95%) Airway interventions (verbal or physical stimulation, bag‐valve mask ventilation, jaw thrust, head tilt, use of a shoulder roll, supplemental oxygen, or reversal agents)* Secondary Oxygen desaturation (SpO₂ < 90%)**
Funding sources	Research grant from government organization (National Center for Advancing Translational Science, components of the National Institutes of Health)
Declarations of interest	Not stated in publication
Notes	Airway interventions: verbal or physical stimulation, bag‐valve mask ventilation, airway repositioning (jaw thrust or head tilt), use of a shoulder roll, supplemental oxygen or reversal agents *Primary outcome was SpO₂ < 95%. Secondary outcome SpO₂ < 90% obtained by contacting author directly.
*Risk of bias*
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	A statistician provided blocked randomization using Proc Plan (Sas 9.2, Cary, NC), with a 7‐digit random seed; group assignments were allocated to participants in a random sequence within blocks of 6.
Allocation concealment (selection bias)	Low risk	Allocation concealed with sealed, opaque envelopes.
Blinding of participants and personnel (performance bias) All outcomes	High risk	Participants and personnel not blinded to capnography screens.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Research associates during procedures not blinded.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Outside of a priori defined exclusion criteria, all data included.
Selective reporting (reporting bias)	Low risk	All participant outcomes accounted for upon contacting author directly.
Other bias	Low risk	Unpublished data for the oxygen desaturation outcome was obtained from author. Funding: supported by an independent government grant.

ETCO₂: end‐tidal carbon dioxide partial pressure; n: number of participants; PSA: procedural sedation and analgesia; RCT: randomized controlled trial; SBP: systolic blood pressure; SpO₂: blood oxygen saturation.

Characteristics of excluded studies [ordered by study ID]

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Study	Reason for exclusion
Deitch 2007	Not relevant interventions: supplemental oxygen vs compressed air for midazolam and fentanyl PSA. Retrospectively analysed blinded capnography data.
Deitch 2008	Not relevant interventions: supplemental oxygen vs compressed air for propofol PSA. Retrospectively analysed blinded capnography data.
Hart 1997	Non‐relevant interventions: RCT comparing fentanyl vs fentanyl‐midazolam vs meperidine‐promethazine‐chlorpromethazine compound as sedation drugs for PSA.
Sivilotti 2010	Non‐relevant interventions: RCT comparing sedation drugs for PSA then retrospectively analysed for adverse events and utility of capnography.

PSA: procedural sedation and analgesia; RCT: randomized controlled trial.

Data and analyses

Open in table viewer

Comparison 1. Capnography plus standard monitoring versus standard monitoring only

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Oxygen desaturation Show forest plot	3	1272	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.48, 1.63]
Open in figure viewer Analysis 1.1 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 1 Oxygen desaturation.
2 Hypotension Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.2 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 2 Hypotension.
3 Emesis, pulmonary aspiration Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected
Open in figure viewer Analysis 1.3 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 3 Emesis, pulmonary aspiration.
4 Airway interventions Show forest plot	3	1272	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.94, 1.69]
Open in figure viewer Analysis 1.4 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 4 Airway interventions.
5 Oxygen desaturation (subgroup analysis) Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only
Open in figure viewer Analysis 1.5 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 5 Oxygen desaturation (subgroup analysis).
5.1 Adults (aged ≥ 18 years)	2	1118	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.37, 1.71]
5.2 Paediatric (aged <18 years)	1	154	Risk Ratio (M‐H, Random, 95% CI)	1.33 [0.49, 3.66]
6 Oxygen desaturation (sensitivity analysis), Deitch 2010 excluded Show forest plot	2	1140	Risk Ratio (M‐H, Random, 95% CI)	1.33 [0.66, 2.69]
Open in figure viewer Analysis 1.6 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 6 Oxygen desaturation (sensitivity analysis), Deitch 2010 excluded.
7 Airway interventions (subgroup analysis) Show forest plot	3	1272	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.94, 1.69]
Open in figure viewer Analysis 1.7 Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 7 Airway interventions (subgroup analysis).
7.1 Adults (aged ≥ 18 years)	2	1118	Risk Ratio (M‐H, Random, 95% CI)	1.44 [1.16, 1.79]
7.2 Paediatric (aged < 18 years)	1	154	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.71, 1.34]

Figure 1

Search flow diagram.

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Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 4

Forest plot of comparison: capnography plus standard monitoring versus standard monitoring, outcome: 1.1 oxygen desaturation.

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Figure 5

Forest plot of comparison: capnography plus standard monitoring) versus standard monitoring, outcome: 1.6 oxygen desaturation (sensitivity analysis based on definition of oxygen desaturation. Deitch 2010 excluded).

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Figure 6

Forest plot of comparison: capnography plus standard monitoring versus standard monitoring, outcome: 1.7 airway interventions (subgroup analysis based on participant age).

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Analysis 1.1

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 1 Oxygen desaturation.

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Analysis 1.2

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 2 Hypotension.

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Analysis 1.3

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 3 Emesis, pulmonary aspiration.

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Analysis 1.4

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 4 Airway interventions.

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Analysis 1.5

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 5 Oxygen desaturation (subgroup analysis).

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Analysis 1.6

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 6 Oxygen desaturation (sensitivity analysis), Deitch 2010 excluded.

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Analysis 1.7

Comparison 1 Capnography plus standard monitoring versus standard monitoring only, Outcome 7 Airway interventions (subgroup analysis).

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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
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)	⊕⊕⊕⊝ Moderate^b	‐
	8 per 1000^a	7 per 1000 (4 to 13)
Hypotension	Medium risk population		RR 2.36 (0.98 to 5.69)	986 participants (1 study)	⊕⊕⊕⊝ Moderate^d	‐
	6 per 1000^c	14 per 1000 (6 to 34)
Emesis, pulmonary aspiration	Medium risk population		RR 3.10 (0.13 to 75.88)	986 participants (1 study)	⊕⊕⊕⊝ Moderate^d	None of the studies recorded pulmonary aspiration events.
	4 per 1000^e	4 per 1000 (1 to 304)
Airway interventions	Medium risk population		RR 1.26 (0.94 to 1.69)	1272 participants (3 studies)	⊕⊕⊕⊝ Moderate^g	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 1000^f	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)	⊕⊕⊕⊝ Moderate^j	‐
	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. ^fBurton 2006. ^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. ⁱCampbell 2016. ^j Downgraded due to heterogeneity in outcome definitions as well as small number of studies.

Summary of findings for the main comparison. Capnography and standard monitoring compared with standard monitoring for emergency department patients undergoing procedural sedation and analgesia

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Comparison 1. Capnography plus standard monitoring versus standard monitoring only

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Oxygen desaturation Show forest plot	3	1272	Risk Ratio (M‐H, Random, 95% CI)	0.89 [0.48, 1.63]

2 Hypotension Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

3 Emesis, pulmonary aspiration Show forest plot	1		Risk Ratio (M‐H, Random, 95% CI)	Totals not selected

4 Airway interventions Show forest plot	3	1272	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.94, 1.69]

5 Oxygen desaturation (subgroup analysis) Show forest plot	3		Risk Ratio (M‐H, Random, 95% CI)	Subtotals only

5.1 Adults (aged ≥ 18 years)	2	1118	Risk Ratio (M‐H, Random, 95% CI)	0.79 [0.37, 1.71]
5.2 Paediatric (aged <18 years)	1	154	Risk Ratio (M‐H, Random, 95% CI)	1.33 [0.49, 3.66]
6 Oxygen desaturation (sensitivity analysis), Deitch 2010 excluded Show forest plot	2	1140	Risk Ratio (M‐H, Random, 95% CI)	1.33 [0.66, 2.69]

7 Airway interventions (subgroup analysis) Show forest plot	3	1272	Risk Ratio (M‐H, Random, 95% CI)	1.26 [0.94, 1.69]

7.1 Adults (aged ≥ 18 years)	2	1118	Risk Ratio (M‐H, Random, 95% CI)	1.44 [1.16, 1.79]
7.2 Paediatric (aged < 18 years)	1	154	Risk Ratio (M‐H, Random, 95% CI)	0.97 [0.71, 1.34]

Comparison 1. Capnography plus standard monitoring versus standard monitoring only

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Referencias

References to studies included in this review

Campbell 2016 {published and unpublished data}

Deitch 2010 {published data only}

Langhan 2015 {published data only}

References to studies excluded from this review

Deitch 2007 {published data only}

Deitch 2008 {published data only}

Hart 1997 {published data only}

Sivilotti 2010 {published data only}

Additional references

Anderson 2007

Burton 2006

Burton 2012

Campbell 2006

Cudny 2013

Egger 1997

EndNote X7.4 [Computer program]

Godwin 2005

Godwin 2014

Green 2010

Guyatt 2008

Higgins 2011

Kodali 2013

Krauss 2007

Langhan 2012

Mallory 2011

McCarney 2007

Miner 2002

Miner 2003

Mohr 2013

RevMan 2014 [Computer program]

Saretsky 1972

Sealed 2012

Swanson 1996

Wright 1992

References to other published versions of this review

Wall 2013

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Characteristics of excluded studies [ordered by study ID]

Data and analyses

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