Using capnography in children to prevent oxygen desaturation during procedural sedation: A randomised trial.

Capnography is essential for ventilatory monitoring. We evaluated the effects of capnography on the occurrence of oxygen desaturation in paediatric patients undergoing sedation outside the operating room. Age-stratified randomised controlled trial without blinding. Tertiary care children's hospital. We enrolled paediatric patients scheduled to undergo sedation outside the operating room with either oral chloral hydrate (25 to 50 mg kg-1), intravenous midazolam (0.1 mg kg-1), ketamine (1 mg kg-1) or a combination of these medications. Patients were allocated to the control and capnography groups that were monitored using pulse oximetry and pulse oximetry plus capnography. The primary outcome was the incidence of oxygen desaturation, defined as a decrease of at least 5% from the patient's baseline oxygen saturation. A total of 256 paediatric patients were screened for eligibility, and 214 were enrolled. Ultimately, data from 197 patients were analysed, with 101 and 96 children in the control and capnography groups, respectively. Oxygen desaturation occurred in 32.7% (n = 33) and 15.6% (n = 15) of the patients in the control and capnography groups, respectively, resulting in an odds ratio (OR) of 0.38 [95% confidence interval (CI), 0.19 to 0.75), P = 0.005]. The oxygen saturation at the time of intervention initiation was higher in the capnography group (93.8 ± 7.8%) compared with the control group (90 ± 7.8%, P = 0.003). The incidence of severe oxygen desaturation less than 90% or less than 85% did not differ between the two groups. Capnography significantly reduced the incidence of oxygen desaturation in paediatric patients undergoing procedural sedation outside the operating room. Our study advocates the integration of capnography with standard pulse oximetry to reduce the incidence of oxygen desaturation during paediatric procedural sedation outside the operating room. Clinicaltrials.gov identifier: NCT04868266.