The Physician-Patient Alliance for Health & Safety today released an interview with Peggy Lange, RT (Director of the Respiratory Care Department, St. Cloud Hospital) about a project that examined acute response team (ART) calls regarding patients who had received procedural or conscious sedation 24 hours prior to the event. 

As Ms. Lange wrote in her article published in ADVANCE for Respiratory Care and Sleep Medicine, “Culture of Safety Includes Capnography”:

“We looked at patient monitoring practices in the outpatient procedural areas and we addressed the very real issue of too many alarms on the hospital patient floor. We also undertook a literature review for the project as we prepared to consider implementing capnography outside the operating room at our institution.”

For the project, St. Cloud Hospital brought together a team of clinicians that included physicians, nurses, respiratory therapists, and pharmacists who represented different clinical areas like pain, sedation, endoscopy, and surgery.

In this interview, Ms. Lange discussed 5 key learnings from this project:

Key Learning #1 – Capnography Assists with Assessment of the Quality of Ventilation

Ms. Lange said that their review of the relevant literature and their experience showed that monitoring with capnography is a valuable tool to assess the patient’s quality of ventilation:

“We reviewed the literature and then budgeted through normal channels for approval for the equipment, and then worked closely with the surgical floor for the trial period. We found that the literature talked about CO2 monitoring was providing an earlier indicator of respiratory compromise before the patient became hypoxic.

“So, even before oximetry would be a reading, CO2 monitoring provided that earlier indication. We found that it was recommended as a tool for procedural sedation. And during the recovery for sedation, we found that end tidal CO2 monitoring was recommended to assist with the quality of ventilation. It was a standard of care for anesthesia for a number of years for intubated and mechanically vented patients, and it’s also in the ACLS guidelines for cardiopulmonary arrest management.”

Key Learning #2 – Monitor Patients Continuously, Not Intermittently

To be effective, capnography monitoring should be done continuously and not intermittently, said Ms. Lange:

“We know that intermittent monitoring can stimulate the patient to a higher level of consciousness. But again, when they’re left alone, they can experience that respiratory depression. We want people to document the trended numbers, not just the numbers when you stimulate somebody, because it’s not giving the full picture to the next caregiver.”

For all five key learnings, please listen to the interview with Ms. Lange on YouTube by clicking here.