Therefore, the use of capnography has not been established as a recognized standard for respiratory monitoring due to other factors, including cost, false alarms, and sensitivity to respiratory abnormalities 16, 17, 18. Clinical trials comparing capnography with standard monitoring have reported controversial results 8, 9, 10, 11, 12, 13, 14, 15, 16, 17. However, capnography does not precisely characterize the nature of breathing because end-tidal carbon dioxide is an indirect and lagging indicator of respiratory status rather than a direct measurement of changes in respiratory volume 6, 7. Therefore, capnography during an endoscopic procedure with deep sedation has been recommended in Japan 5. Furthermore, the American Society for Gastrointestinal Endoscopy suggested that capnography be considered for patients undergoing endoscopy targeting deep sedation 4. The European Society of Gastrointestinal Endoscopy recommended that capnography be considered during the administration of propofol in specific situations, including high-risk patients, intended deep sedation, and long procedure duration 3. Therefore, appropriate use of cardiorespiratory monitoring is recommended during and after endoscopy with sedation. Even tracheal intubation (0.09%) and death (0.03%) have occurred in some cases where propofol was used for sedation in endoscopy 2. Furthermore, cardiopulmonary events during endoscopy are described to be the most important fatal complications 1. However, hypoxemia associated with respiratory depression or hemodynamic instability is well known to occur frequently during sedation. The upper interventional endoscopy procedures of endoscopic submucosal dissection (ESD), endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA), and double-balloon enteroscopy (DBE) are currently performed under sedation with sedative agents, including propofol, dexmedetomidine, and benzodiazepine, and analgesics, including fentanyl, pentazocine, and pethidine, to reduce patient distress and achieve successful completion. Nasal pressure monitoring is safe and possibly useful for respiratory monitoring despite false alarms during sedation. Harmful events unrelated to nasal pressure monitoring occurred in 2 patients. In the 43 patients, false alarms were detected in 7 patients with capnography and 11 patients with nasal pressure monitoring ( p = 0.427).
In these 12 patients, more than half of the desaturation events were predictable in 9 patients by capnography and 11 patients by nasal pressure monitoring ( p = 0.59). At least one desaturation event occurred in 12 patients (27.9% 95% confidence interval 15.3–43.7%). Of the 45 participants, 43 completed the study. The secondary outcomes were the ability to predict the desaturation and incidence of harmful events and false alarms, defined as an apnea waveform lasting more than 3 min without desaturation.
The primary outcome was the incidence of oxygen desaturation below 90%. While both nasal pressure and capnograph signals were continuously recorded, only the nasal pressure signal was displayed. A total of 45 adult patients undergoing sedation with propofol and fentanyl for invasive endoscopic procedures were enrolled.
This study aimed to assess its safety for respiratory monitoring during sedation.
CAPNOGRAPHY RANGE PORTABLE
Portable handheld NDIR devices provide measurements of End-tidal C02 and Respiratory rate normally known as a capnometer, as standard or End-tidal C02 and Respiratory rate combined with Inspired C02 and Oxygen Saturation and Pulse Rate with numerical, capnogram, plethysmogram and trending displays in a single handheld portable monitor.Nasal pressure signal is commonly used to evaluate obstructive sleep apnea. The displays may also show the inspired FiCO2, which is of interest when rebreathing systems are being used. Measurements are usually presented as a numerical value, bar graph or capnograph of expiratory EtCO2 plotted against time, or more usefully, expired volume.
CAPNOGRAPHY RANGE PLUS
The most accurate measurement technology is Non Dispersive Infrared, portable capnography devices are used as a monitoring tool during anaesthesia, intensive care, emergency use for efficacy of tube placement during intubation and for patient transfer inter/intra hospital and emergency ambulance retreival, and for use non-intubated patients for airway and respiratory lung function assessment using two way face mask plus a valuable tool for monitoring Chronic obstructive pulmonary disease. Capnography is the monitoring of the concentration of end tidal carbon dioxide (EtCO2) in the respiratory gases.
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