128 Systematic monitoring of etco2 in procedural sedations: a relevant medical practice or not?
Notice bibliographique
Résumé
Objectives Clinical monitoring of all patients should be performed during procedural sedation to prevent possible complications including airway obstruction, apnea and hypotension. Capnography, which measures end-tidal carbon dioxide (ETCO2), is a non-invasive monitoring method that provides information about metabolic, circulatory and respiratory activities. ETCO2 could be added to other standard monitoring during procedural sedation as measurements of blood pressure, pulse, respiration, and oxygen saturation to allow early detection of critical respiratory incidents. This project aims to determine if ETCO2 should be mandatory in our hospital to ensure the safety of care during procedural sedation. Method Literature search was conducted in indexed databases and grey literature between January 1 st 2005 and April 12th 2018. Systematic reviews (SRs), clinical practice guidelines (CPGs) and primary studies on the use of ETCO2 monitoring in adults or children under procedural sedation were retrieved. Two reviewers independently performed selection, quality assessment and data extraction. Outcomes included respiratory depression rate, interventions needed to respiratory support, cardiac arrest, desaturation, hypotension, antagonist administration and false alarms. Two hospital databases were consulted to estimate the volume of procedural sedations performed during the financial year 2016–2017. Reported accidents were also retrieved from hospital database between January 1 st 2012 and March 21 st 2018. Results Six SRs and 26 CPGs were analyzed. Although CPGs recommendations are based on poor scientific evidence, they mainly targeted propofol administration or deep level sedation for the use of ETCO2. Results from meta-analyses (n=4) suggest a statistically significant lower risk of desaturations with the ETCO2 in addition to standard monitoring compared to standard monitoring. Heterogeneity between studies (desaturation definitions, procedures, depth of sedation, sedatives, oxygen administration) invites caution regarding the interpretation of these data. Effects of ETCO2 use on other outcomes remain undetermined. No serious complication with ETCO2 use during procedural sedation was reported. More than 30 000 interventions with procedural sedation are performed each year in our hospital, mainly related to emergency, gynecologic, radiologic and endoscopic procedures. The addition of ETCO2 to clinical monitoring was only found in the emergency department. Adverse events during procedural sedations were reported in two cases according to the hospital database. Conclusions The addition of ETCO2 to standard monitoring could possibly improve clinical management of procedural sedations by reducing desaturation events. However, the clinical significance to prevent such events on serious respiratory outcomes is unclear. Because results mainly refer to deep sedation with propofol, no firm conclusion can be drawn regarding ETCO2 use in case of minimal to moderate procedural sedations. Considering the risk of unnecessary medical interventions, clinicians should be advised to use ETCO2 in specific procedural sedations instead of systematically.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,070 | 0,288 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,004 |
| Bibliométrie | 0,014 | 0,017 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,004 | 0,005 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,004 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,007 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».