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The Effectiveness of Capnography Versus Pulse Oximetry in Detecting Respiratory Adverse Events in the Postanesthesia Care Unit (PACU): A Narrative Review and Synthesis
The objective of this review was to evaluate the effectiveness of capnography monitoring versus standard monitoring of pulse oximetry in detecting respiratory adverse events in nonintubated pediatric and adult postanesthesia care unit (PACU) patients.
Design
Experimental, quasi-experimental, and observational studies examining pulse oximetry and capnography in adult and pediatric patients in the PACU were included in this systematic review.
Methods
An initial search of MEDLINE and CINAHL, PubMed, Web of Science, Prospero, Google Scholar, and Cochrane was undertaken to identify articles on the topic. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy in July 2019. Reference lists of studies included at critical appraisal stage were hand-searched. Studies published in English from 1978 onward were included.
Findings
Meta-analysis was not possible due to variation in outcome measurements; therefore, results are presented in narrative form. Four studies were included in the review: 1 randomized controlled trial (RCT) and 3 observational cross-sectional studies. The RCT was considered of moderate to high quality, and the observational cross-sectional studies were of high quality. The main findings of this review suggest that there is limited high-quality evidence that capnography improves detection of respiratory adverse events in the PACU versus pulse oximetry.
Conclusions
The lack of RCTs and varied outcomes measures in the 4 studies reviewed meant that meta-analysis was not possible. Early detection of respiratory adverse events afforded by the addition of PETCO2 to SpO2 in the PACU was seen in these studies. More research is needed to determine if widespread implementation of capnography in addition to pulse oximetry would reduce severity of respiratory related adverse events in the PACU through more timely identification.
Registered nurses in the postanesthesia care unit (PACU) monitor the cardiopulmonary status of pediatric and adult patients after a procedure or surgery in which sedation, opioids, or anesthesia have been administered. Standard monitoring includes cardiac rhythm, blood pressure, respiratory rate, and pulse oximetry with monitoring of the percentage of peripheral hemoglobin saturated with oxygen (SpO2).
Physical assessment alone is not adequate to identify a compromise in respiratory status. The gold-standard of respiratory assessment is arterial blood gas analysis; this measures partial pressure of oxygen (PaO2), providing information on oxygenation status, and the partial pressure of carbon dioxide (PaCO2), providing information on ventilation status.
The PaCO2 reflects pulmonary ventilation and cellular CO2 production. It is a more sensitive marker of ventilatory failure than PaO2, particularly in the presence of supplemental oxygen, as it has a close relationship with the depth and rate of breathing.
Arterial blood gas analysis is invasive, expensive, reflects a snapshot in time, and test results are not immediately available. Pulse oximetry is an evaluation of oxygenation. Capnography with monitoring of the partial pressure of end-tidal carbon dioxide (PETCO2) is an evaluation of ventilation. An advantage is that each provides instantaneous, continuous data, and is noninvasive.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
Capnography measures PETCO2 and can provide critical and timely information regarding the patient's ventilatory status, giving an early warning of compromise.
Periods of apnea, decreased respiratory rate, and hypoventilation are readily detectable with capnography monitoring. For the last decade, leaders in the American Society of PeriAnesthesia Nurses (ASPAN) have called for the addition of capnography to the standard of care for postanesthesia monitoring of ventilatory status to prevent severe respiratory adverse events.
Capnography monitoring has become the standard for monitoring ventilatory status worldwide in the OR during surgical procedures requiring anesthesia. In 1978, Holland was the first country to adopt this as the standard practice.
Advances in technology pushed capnography beyond the OR and facilitated monitoring of patients with both artificial and natural airways undergoing procedural sedation and monitored anesthesia care. Years ago, the American Society of Anesthesiologists established capnography as the standard for monitoring ventilation in patients undergoing procedural sedation.
Recommendations for standards of monitoring during anesthesia and recovery published in 2015 by the Association of Anaesthetists of Great Britain and Ireland included capnography as the standard for monitoring ventilation in the PACU for patients with artificial airways and if deeply sedated.
do not include a strong recommendation for capnography to monitor patients in PACU during the first phase of recovery. In Practice Recommendation 2B, Postanesthesia Phases of Care, Initial and Ongoing Assessment: Phase 1, Airway assessment includes ‘‘End-tidal CO2 (capnography) monitoring if available and indicated.”
Many PACUs do not have the equipment for this capability, others struggle to select and triage which specific patients meet capnography indications. The capnography monitoring standard that was adopted for procedural sedation was not integrated for postanesthesia care. The lack of a recommendation for capnography as a standard in the ASPAN guidelines presents a potential barrier to obtaining capnography equipment that may optimize care and outcomes.
Many have called for the use of capnography in patients with obstructive sleep apnea who receive opioids, in settings from the PACU to the medical-surgical unit.
Opioids are related to respiratory adverse events in patients in the PACU and inpatient units. Postsurgical patients experiencing opioid-related adverse drug events have 55% longer hospital stays, 47% higher costs associated with their care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality compared to those with no opioid-related adverse drug events.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system.
This systematic review will explore the evidence regarding the effectiveness of capnography to provide an earlier indication than pulse oximetry of development of a respiratory adverse event for patients in the PACU. Respiratory adverse events were defined as respiratory depression, hypercapnia, hypoventilation, apnea, bradypnea, hypoxemia, and postoperative respiratory failure.
Participants
The population of interest in the review includes patients living world-wide, regardless of geographic placement, adult (greater than 18 years), and pediatric (1 month to 18 years). Research studies that included nonintubated pediatric and adult patients that were admitted to the PACU after a procedure or surgery were included. The search did not include neonates or infants 1 month or less.
Interventions
Routinely, the perianesthesia nurse places the pulse oximetry device on a patient on admission and maintains it throughout the patient's stay in the PACU Phase I, or until criteria for removal are met. This review considered studies that compare capnography and PETCO2 to standard monitoring pulse oximetry and SpO2 and evaluated the respiratory outcomes related to capnography monitoring among children and adults in the PACU.
Outcomes
The following primary outcomes were measured in the studies considered: Adverse respiratory events, respiratory depression, hypercapnia, hypoventilation, apnea, bradypnea, and hypoxemia.
Types of Studies
This review considered both experimental and quasi-experimental study designs including randomized controlled trials (RCTs), non-RCTs, before and after studies, and interrupted time-series studies. In addition, analytical observational studies including prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies were considered for inclusion.
Methods
This systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of effectiveness.
McNeill M, Hardy Tabet C. The effectiveness of capnography in detecting adverse events in the postanesthesia care unit (PACU): A quantitative systematic review protocol, # 11733, registered 7.6.2019, through Joanna Briggs Institute, 2019.
An initial search of PubMed was undertaken followed by analysis of the text words contained in the title, abstract, and the index terms used to describe the articles on July 8, 2019. MeSH terms searched included capnography, carbon dioxide monitoring, end tidal, PETCO2, postsurgical, postoperative, postoperative, postoperative, recovery room, anesthesia recovery period, postanesthesia, PACU, postanesthesia nursing, postanesthesia care unit. The search focused on health care studies published in English since 1978, when capnography was adopted in medicine. A second search using the same keywords and index terms was undertaken on July 11, 2019, for CINAHL, PubMed, Web of Science, Prospero, Google Scholar, Cochrane. Finally, the reference lists of all reports and articles selected for critical appraisal were searched for additional studies.
Study Selection
Following the search, all identified citations were loaded into Endnote 20 (Clarivate Analytics, Boston, Massachusetts) and duplicates removed. A total of 218 articles were identified. Once articles from all databases were collated, duplicate articles were removed, leaving 98 titles for screening. Titles and abstracts for the review were screened by 2 independent reviewers for assessment against the inclusion criteria. Forty-two articles proceeded to full-text screening by the same reviewers. Studies that did not meet the inclusion criteria were excluded. Any differences that arose between the reviewers were resolved through discussion. In total, 4 articles progressed to quality appraisal and were included in the review. One RCT and 3 cross-sectional observational studies were reviewed. The results of the search are presented in a preferred reporting items for systematic reviews and meta-analyses flow diagram
Figure 1Description of studies considered for review. Adapted from: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA Statement. PLoS Med. 2009; 6(6):e1000097. doi:10.1371/journal.pmed1000097.
Eligible studies were critically appraised by 2 independent reviewers using Joanna Briggs Institute critical appraisal tools for experimental and quasi-experimental studies.
The RCT was scored as 8 out of 13, considered to be of moderate quality for a RCT. Of note, the intervention could not be blinded, negatively affecting the quality scores. For the cross-sectional observational studies, all were scored 8 out of 8, considered high quality for the study design. The Grading of Recommendations, Assessment, Development and Evaluation approach for grading the certainty of evidence was used for each study,
using GRADEPro GDT 2020 (McMaster University, ON, Canada), to rank the quality of the evidence based on the risk of bias, directness, heterogeneity, precision, and risk of publication bias of the review. The RCT was found to be of high quality, and each of the cross-sectional observational studies was of low quality. A summary of findings table could not be produced due to the variations in outcomes.
Data Extraction and Synthesis
Data extraction and statistical pooling were not possible due to the limited number of studies and the variety of outcome measures used; no two studies used the same outcome measures. As a result, the findings are presented in narrative form.
307 children were consented, 211 were randomized to the 2 groups, and data from 201 children were analyzed. Patients who were able to tolerate the capnography cannula were randomized as to whether staff could view the capnography monitor screen (intervention) or were blinded to the capnography monitor screen but could view the usual monitoring (controls). Children were excluded if they needed postoperative assisted ventilation via an endotracheal tube or tracheostomy, urgent or emergent surgical procedures, or surgery that would preclude the use of a nasal-oral cannula used for capnography monitoring (eg, facial reconstruction), the inability to tolerate the nasal-oral cannula because of emergence delirium, psychomotor agitation during emergence from anesthesia, any disease or state that may lead to abnormal capnography values, or baseline abnormalities in pulse oximetry.
Before starting enrollment, PACU nurses were educated on the capnography monitor, interpretation of waveforms, and noninvasive nursing interventions for abnormal findings. After randomization, all children received monitoring with pulse oximetry, and standard nursing care. For the intervention group, alarm settings on the monitor were programmed to alert the PACU staff to PETCO2 levels below 30 mm Hg and above 50 mm Hg, as well as a respiratory rate of 0 for more than 20 seconds. The monitor was positioned so it was easily seen by the PACU nurses. For patients in the control group, the capnography monitor was not visually or audibly accessible to the staff. Of the 201 children whose data were analyzed, 103 were in the intervention group and 98 were in the control group.
Research associates recorded the data. Primary outcomes were frequency of respiratory depression measured by capnography, oxygen desaturations measured by pulse oximetry, and staff interventions for these events. The outcomes were graded by severity. Respiratory depression included both hypopneic and bradypneic hypoventilation and apnea. Hypopneic hypoventilation was defined as a PETCO2less than or equal to 30 mm Hg for more than 30 seconds without a rise in respiratory rate more than 50% of the patients mean value as caused by a decrease in tidal volume. Bradypneic hypoventilation was defined as a PETCO2greater than or equal to 50 mm Hg for more than 30 seconds was caused by a decrease in respiratory rate. Apnea was defined as a PETCO2 of 0 mm Hg for a minimum of 20 seconds.
The sample size and statistical analysis were appropriate and well described.
The results indicated the trajectories of respiratory event rates over time were significantly different between groups. The rate or the proportion of subjects with an episode of hypopneic hypoventilation during a minute of recovery decreased over time in both groups, but the change in rate was significantly greater in the capnography group compared to the pulse oximetry group (5% per minute vs 1% per minute; difference 4%, 95% CI: 0.2% to 8%; P = .04). The same trend was seen for apnea (intervention 11% per minute vs control 1.5% per minute, difference 10% per minute, 95% CI: 5% to 14%; P < .001). Bradypnea declined faster over time in the control group (5% per minute vs 1% per minute, difference 4% per minute, 95% CI: 0% to 9%; P = .05). Further stratified analysis demonstrated that these differences in hypoventilation events were significant only among patients who received an intervention from the staff such as stimulation. Among patients who received an intervention, the slope difference in declining likelihood of a hypopneic event between 2 arms was 9% per minute (95% CI: 2% to 13%; control -1% per minute vs intervention -9% per minute, P < .001).
Capnography detected apnea in 29% of patients in this study. As expected since most of the children were receiving oxygen, there were no statistically significant differences between groups in the rates of oxygen desaturations.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
was a cross-sectional observational study designed to compare 3 types of electronic monitoring devices (pulse oximetry, capnography, and minute ventilation) to determine which were more effective at identifying the patient experiencing opioid-induced respiratory depression in the form of hypoventilation. Minute ventilation was measured with the only FDA approved device for such monitoring, which uses 2 chest leads to detect tidal volume and respiratory rate. The researchers also aimed to develop algorithms from this electronic monitoring data to aid in earlier detection of respiratory depression. Forty-eight of the 60 patients recruited on the day of their surgery at a community hospital wore the 3 types of monitoring equipment. STOP-BANG assessments were also collected for each patient preoperatively before administration of any medications. The patients underwent back, neck, hip, or knee surgeries. Pulse oximetry was applied and monitored per usual standards of care in the PACU, while the researchers collected the capnography and minute ventilation data every 2 minutes at the bedside. The experimental capnography and minute ventilation data were not used to influence the care delivered by the PACU nurses.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
The main outcome of this study was opioid-induced respiratory depression events, defined as a change in respiratory status within 10 minutes of opioid administration. These changes were defined as a drop in SpO2 below 90%, PETCO2 at or above 50, or minute ventilation less than 40% of predicted.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
Twenty-six of the 48 patients exhibited signs of opioid-induced respiratory depression. The SpO2 measures did not change, but PETCO2 increased and minute ventilation decreased, indicating hypoventilation.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
Capnography and minute ventilation monitoring were found to be effective tools in detecting opioid-induced respiratory depression in the PACU. Pulse oximetry was found ineffective.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
was a cross-sectional observational study designed to determine the frequency of hypoventilation and apnea as detected by capnography among children in the PACU. A convenience sample of 194 pediatric patients aged 1 to 17 years that met inclusion criteria were included from a total of 266 recruited on the day of their surgery at an urban tertiary care hospital. The patients underwent a variety of surgeries; 33% underwent ear, nose, and throat procedures. Exclusion criteria were similar to the RCT described above, conducted by the same team.
Nurses were blinded to the monitor, and the audible alarm on the monitor was disabled. Children otherwise received standard monitoring with pulse oximetry and standard care. Research associates recorded the study data. Outcome measures included frequency of hypoventilation and apnea as measured by capnography and oxygen desaturations as measured by pulse oximetry, as well as staff interventions for these events.
Eighty-seven patients (45%) had hypoventilation events. Thirty-six (19%) had apnea events. Thirty-six (19%) had oxygen desaturation events, 9 (5%) with SpO2 measured at less than 85% on room air or less than 90% on supplemental oxygen, and 4 (2%) were severe, less than 80% on room air or less than 85% on supplemental oxygen. Eighty-eight patients (45%) had no adverse events. All results were within the upper and lower values of 95% confidence intervals. Patients who received opioid medications were more likely to experience hypoventilation (OR 2.3, 95% CI: 1.02, 5.3) and apnea (OR 2.7, 95% CI: 1.1, 7). No invasive interventions were implemented.
The researchers felt that because they found an association between the use of supplemental oxygen and hypoventilation among the patients, this highlights the importance of additional forms of monitoring, because pulse oximetry alone may fail to identify respiratory depression.
Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: A blinded observational trial.
was a prospective multicenter observational pilot trial conducted in the PACU of 2 medical centers, 1 in the United States and 1 in Canada. The purpose of this trial was to determine the frequency and duration of capnography-detected respiratory adverse events in the PACU. Included were adult patients aged 18 years and older, with American Society of Anesthesiologists scores of II to IV, scheduled for an elective surgery requiring general anesthesia of greater than 90 minutes duration, who required intraoperative opioids, stayed in the PACU 45 minutes or longer, and were expected to be admitted to an impatient setting from the PACU. A respiratory adverse event was defined as being outside normal ranges for oxygenation, ventilation, or both. Critical respiratory adverse events were defined as any unanticipated respiratory adverse event requiring active intervention. Interventions included airway protective methods, opioid or muscle relaxant reversal/antagonism, and airway manipulation.
In addition to standard monitors, all patients were monitored using a capnography device. The monitor screen was blinded, and all alerts were silenced. A second pulse oximeter (an addition to standard pulse oximetry monitoring) was used for data collection and Integrated Pulmonary Index algorithm calculations. Monitoring continued for a minimum of 45 minutes until patients were transferred out of the PACU. Chart review continued for 24 hours after patient transfer.
Of the 172 patients who completed the trial, 135 (78%) had one or more Level I (physician) notification, and 163 (95%) had one or more Level II (nurse) notification. Levels I and II notifications were based on patient monitor thresholds deemed clinically important enough to notify a physician (Level I) or a nurse (Level II). Notification settings were set for detection of apnea lasting greater than or equal to 10 seconds. The most common respiratory adverse events detected by capnography included hypocapnia, apnea, tachypnea, bradypnea and hypoxemia, with notification duration ranging from 17 ± 13 to 189 ± 127 seconds.
Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: A blinded observational trial.
Throughout the trial, 16 (9.25%) patients were observed by standard monitoring to have decreased oxygen saturation. In the PACU, standard monitoring detected 15 respiratory adverse events, including 1 case (0.58%) of decreased respiratory rate and 1 case (0.58%) of hypercapnia.
Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: A blinded observational trial.
The authors concluded that this multicenter pilot trial demonstrated that respiratory adverse events are frequent in the PACU, and the addition of capnography to standard pulse oximetry monitoring provides potentially clinically useful information to help identify and prevent respiratory compromise.
Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: A blinded observational trial.
In the RCT, the addition of capnography to routine monitoring in the pediatric PACU led to lower rates of hypopneic hypoventilation and apnea over time. Bradypnea increased over time in patients monitored by capnography; the researchers thought staff may have intervened differently based on the monitoring information available to them and the education provided before the start of the study. A decline in respiratory rate in the noncapnography group may have prompted early interventions, while the same information may have been tolerated because of additional availability of PETCO2.
In the second study, capnography and minute ventilation were found to be effective tools in detecting respiratory compromise in the PACU. Pulse oximetry was found to be ineffective.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
In the third study, patients who received opioid medications were more likely to experience hypoventilation. Hypoventilation was seen more often among children who received supplemental oxygen. Hypoventilation and apnea were common among children in the PACU; however, few interventions occurred to address these events.
Adding capnography monitoring to other monitors has the potential to alert clinicians to these episodes before they occur, allowing for proactive intervention in the PACU before discharge to the ward.
In a subset of patients in the fourth study, 6 of 8 patients who had respiratory adverse events detected by standard care also had respiratory episodes detected by the individual blinded capnography parameters. Five of these capnography-detected events were identified before standard care monitors reported the respiratory adverse event, with an average warning time of 8 minutes, suggesting that capnography can provide early warning of patient ventilatory challenges in the PACU.
The main findings suggested that there is limited high-quality evidence that the addition of capnography improves early detection of adverse respiratory events in the PACU versus pulse oximetry alone. A fundamental issue limiting comparisons across studies in this review was the variety of outcome measures used. Only 1 RCT was conducted to examine the use of capnography in the PACU.
Main Limitations of Included Studies
The studies could not control the behavior of staff responsible for patient monitoring. Capnography may not have been viewable by the staff, but by virtue of being observed, practice may have been different or staff more vigilant during the conduct of the study. Using a convenience sample may have resulted in selection bias in the cross-sectional studies. Practices of the clinicians across study settings can vary, affecting outcomes. Data on anesthesia management were not collected. The impact of capnography monitoring on length of stay or cost was not measured. Analyses would also need to be performed to evaluate the cost-effectiveness of monitoring. Serious adverse events such as the need for reintubation were not captured since these events are extremely rare.
One study occurred in a select group of orthopaedic patients at one hospital, limiting generalizability.
Limitations of the Review
Very few studies were located that objectively measured the effectiveness of capnography versus pulse oximetry on detection of respiratory adverse events in the PACU, which significantly limits the conclusions that can be drawn. Only 1 RCT was found and included. A further limitation is that meta-analysis was not possible, impacting the conclusions that can be drawn.
Conclusions
From the evidence reviewed, there is 1 experimental study and 3 cross-sectional observational studies that suggests capnography is effective at early detection of adverse respiratory events such as apnea and hypoventilation sooner than pulse oximetry in the PACU. On applying the JBI FAME criteria
to evaluate the Level of Evidence as presented in the 4 studies reviewed, capnography received a E2A scale ranking. The addition of capnography to routine monitoring in the pediatric PACU led to lower rates of hypopneic hypoventilation and apnea over time, which may have been due to more effective interventions by nursing staff.
Pulse oximetry monitors oxygenation, and capnography monitors ventilation. This review sought to compare the 2; in fact, these are measures of 2 different aspects of respiration; monitoring both provides a more complete reflection of respiratory status. Both require evaluation of waveforms and data to ensure accuracy. The evidence from this review suggests that capnography would be a valuable addition for perianesthesia nurses monitoring patients in the PACU for adverse respiratory events. As new monitors are purchased for PACUs, the findings suggest the capability to monitor capnography be considered. The cost of this additional monitoring should be weighed in balance with the ability to detect adverse events and their potential effects on morbidity and mortality.
Routine monitoring with capnography may improve recognition of respiratory adverse events and enhance patient safety in the PACU. While the cost of a nasal-oral cannula may not be exorbitant, the addition of this disposable item along with upgrades to patient monitors to include capnography monitoring can be a significant expense. This needs to be considered along with resource utilization and impacts on length of stay.
Further rigorous research is needed to examine the impact of capnography on outcomes secondary to detection of adverse respiratory events in the PACU. Observational studies may be enlightening to compare outcomes before and after capnography capability is available in a PACU. If capnography is employed in the PACU, and detects adverse respiratory events earlier, research on the effects on length of length of stay would be informative. Studies on the population that would most benefit from capnography monitoring to establish criteria for use would also be beneficial.
Research on the relationship between PETCO2 and cardiac output has shown a correlation in ventilated patients
Advances in this area may provide useful information for cardiac assessment of patients in the PACU.
Acknowledgments
The authors would like to acknowledge the American Society of PeriAnesthesia Nurses for the opportunity to attend a 2019 Joanna Briggs Institute Training Grant.
Appendix I
Mesh terms searched in PubMed included capnography, carbon dioxide monitoring, end tidal, ETCO2, post surgical, post operative, postoperative, post-operative, recovery room, anesthesia recovery period, postanesthesia, PACU, post anesthesia nursing, post anesthesia care unit.
PubMed 1683 + CINAHL 9,787 = Total 11,470
PubMed total 1683:
Search ((("Capnography"[Mesh]) OR ((Capnography or carbon dioxide monitoring or end tidal or ETCO2)))) AND (((((post-surgical) OR post-operative) OR post operative) OR (("Postoperative Period"[Mesh]) OR ("Recovery Room"[Mesh] OR "Anesthesia Recovery Period"[Mesh] OR "Postanesthesia Nursing"[Mesh]))) OR (post anesthesia care unit or PACU or recovery)) Filters: Publication date from 1978/01/01 to 2019/12/31; English
CINAHL total9787
(MH "Pulse Oximetry") OR (MH "Pulse Oximeters") OR (MH "Oximetry") 4,659
(MH "Post Anesthesia Care Units") OR (MH "Post Anesthesia Care") OR (MH "American Society of PeriAnesthesia Nurses") OR (MH "Anesthesia Recovery") 3,965
(MH "Capnography") 1163
Other Sources
Items found in Web of Science 77-97: (capnography or end tidal or etco2) and (post anesthesia care unit or PACU or recovery) and pulse oximetry
Items found in Prospero 3: (capnography or end tidal or etco2) and (post anesthesia care unit or PACU or recovery) and pulse oximetry
Items found in Cochrane 1: (capnography or end tidal or etco2) and (post anesthesia care unit or PACU or recovery) and pulse oximetry
Items found in Google Scholar: 434: (capnography or end tidal or etco2) and (post anesthesia care unit or PACU or recovery) and pulse oximetry
Number of articles assessed for quality (N=34); Number of articles excluded on critical appraisal (N=30); Number of articles included (N=4)
References
American Society of PeriAnesthesia Nurses
2021-2022 Perianesthesia Nursing Standards, Practice Recommendations and Interpretive Statements.
Identifying patients experiencing opioid-induced respiratory depression during recovery from anesthesia: the application of electronic monitoring devices.
Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system.
in: Aromataris E Munn ZE Joanna Briggs Institute Reviewer’s Manual. The Joanna Briggs Institute,
University of Adelaide, South Australia2020 (Available at:)
McNeill M, Hardy Tabet C. The effectiveness of capnography in detecting adverse events in the postanesthesia care unit (PACU): A quantitative systematic review protocol, # 11733, registered 7.6.2019, through Joanna Briggs Institute, 2019.
Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: A blinded observational trial.
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