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Capnography for Monitoring End-Tidal CO2 in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]

Anesthesiologists have been using capnography for decades to monitor end-tidal carbon dioxide (ETCO2) in patients receiving general anesthesia. ETCO2 monitoring using capnography devices has application across several hospital and pre-hospital settings, including monitoring the effectiveness of cardiopulmonary resuscitation (CPR), continuous monitoring of patients in the emergency room or intensive care unit (ICU), during ambulatory transport, to confirm the correct placement of an endotracheal tube (ETT), and monitoring post-operative patients with a history of sleep apnea or who have received high doses of opioids. Depending on the clinical area, the technology is at various stages of adoption.

CADTH Health Technology Assessment - Canadian Agency for Drugs and Technologies in Health.

Version: March 2016
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Use of capnography in emergency department patients being sedated for procedures

Medications are often used in order to reduce pain or awareness (or both) for patients having painful procedures. Sometimes, complications involving a patient's heart, lungs, or airway (breathing tubes) can occur due to these medicines (e.g. vomit inhaled by the lungs). Healthcare workers monitor heart rate, blood pressure, breathing rate, and blood oxygen content to help prevent complications.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2017

Capnography as a diagnostic tool for pulmonary embolism: a meta-analysis

STUDY OBJECTIVE: Multiple studies have evaluated capnography for the diagnosis of pulmonary embolism; accordingly, we conduct a meta-analysis of these trials.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Patient safety in ambulance services: a scoping review

This study aimed to identify and map available evidence relating to patient safety when using ambulance services. There was inconsistency of information on attitudes and approaches to patient safety, exacerbated by a lack of common terminology. Patient safety needs to become a more prominent consideration for ambulance services and development of new models of working must include adequate training and monitoring of clinical risks. Providers and commissioners need a full understanding of the safety implications of introducing new models of care. Areas requiring further work include the safety surrounding discharging patients, patient accidents, equipment and treatment, delays in transfer/admission to hospital, and treatment and diagnosis, with a clear need for increased reliability and training for improving handover to hospital.

Health Services and Delivery Research - NIHR Journals Library.

Version: May 2015
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What is the best sedative technique for patients undergoing endoscopic cholangiopancreatography (ERCP)?

Patients have to be given medicines to make them adequately drowsy (sedated) or unconscious (anaesthetized) to tolerate the ERCP procedure. These medicines may be administered by anaesthetic or non‐anaesthetic healthcare personnel, and there is currently some debate as to who should administer these drugs to patients for ERCP procedures.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Sedation in Children and Young People: Sedation for Diagnostic and Therapeutic Procedures in Children and Young People [Internet]

Many children present to hospitals and dental clinics needing effective sedation or anaesthesia for painful or distressing diagnostic or therapeutic procedures. There are many sedation techniques available but there is insufficient guidance on which techniques are effective and what resources are required to deliver them safely. Sedation is not always effective enough and will occasionally require the procedure to be delayed until the child can be anaesthetised perhaps in another healthcare setting or on another day. Consequently sedation failure is both distressing for the child and has major NHS cost implications. Excessive doses of sedation can cause unintended loss of consciousness and dangerous hypoxia. In comparison, planned anaesthesia is effective, but may have resource implications. The need for sedation or anaesthesia will depend upon the type of procedure. Some types of procedures are very common and healthcare providers and practitioners need to understand whether sedation or anaesthesia is the most cost effective method of managing them

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2010
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VA Evidence-based Synthesis Program Evidence Briefs [Internet]

The Department of Veterans Affairs, Health Services Research & Development Service (HSR&D) Evidence-based Synthesis Program (ESP) provides timely and accurate evidence briefs on targeted healthcare topics of particular importance to VA managers and policymakers, as they work to improve the health and healthcare of Veterans. The ESP disseminates these briefs throughout VA.

Department of Veterans Affairs (US).

Version: 2011
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Post-Operative Monitoring Equipment in Patients with Sleep Apnea: A Review of Clinical Effectiveness and Guidelines [Internet]

This report will review the evidence of clinical effectiveness of postoperative monitoring equipment in patients with sleep apnea, and the guidance on postoperative monitoring in the study population from the clinical practice guidelines.

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: May 14, 2015
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Optimal Strategies for the Diagnosis of Acute Pulmonary Embolism: A Health Technology Assessment — Project Protocol [Internet]

Of the total population of patients who are evaluated for suspected PE, few are confirmed to have the condition, indicating a low diagnostic yield of current evaluation methods. Studies report a range of values for the diagnostic yield of CTPA, ranging from less than 5% to 30%, depending on the clinical characteristics of the patient pool, and use of risk stratification strategies. False-positive test results, which, depending on pretest probability, can occur in approximately 10% to 42% of patients who undergo CT scanning, can lead to unnecessary anticoagulation therapy, which carries substantial risk of adverse effects including hemorrhage (occasionally devastating or fatal), interactions with other medications, inconvenience in terms of attendance for repeated blood tests (possibly requiring time off work), implications for future dental and medical procedures, and costs (both to the patient and society). False-negative CT results, which also occur at high frequency (e.g., 1% to 11%), can lead to bypass of necessary treatment, complications, and death. The uncertain benefit of increased testing and the significant expense of PE could suggest that current CT utilization patterns for the diagnosis of PE are not cost-effective. This is reflected in the increased diagnosis of mild PEs, which, if treated, may increase costs and possible harms, and may not reduce mortality. In light of these concerns, it is important to assess whether there are other cost-effective and safe alternatives.

CADTH Optimal Use Report - Canadian Agency for Drugs and Technologies in Health.

Version: September 29, 2016
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Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy): Diagnosis and Management of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy) in Adults and Children [Internet]

The guideline covers care provided by healthcare professionals who have direct contact with and make decisions about the care of people with chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) (CFS/ME). It covers care provided in primary and secondary care, and in specialist centres/teams.

NICE Clinical Guidelines - National Collaborating Centre for Primary Care (UK).

Version: August 2007
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Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care

This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Use of end-tidal carbon dioxide detection to determine correct placement of nasogastric tube: a meta-analysis

OBJECTIVE: To review the diagnostic accuracy of end-tidal carbon dioxide detection in detecting inadvertent airway intubation and verifying correct placement of nasogastric tubes.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Systematic review and meta-analysis of end-tidal carbon dioxide values associated with return of spontaneous circulation during cardiopulmonary resuscitation

OBJECTIVE: End-tidal carbon dioxide (ETCO2) measurements during cardiopulmonary resuscitation (CPR) reflect variable cardiac output over time, and low values have been associated with decreased survival. The goals of this review are to confirm and quantify this relationship and to determine the mean ETCO2 value among patients with return of spontaneous circulation (ROSC) as an initial step toward determining an appropriate target for intervention during resuscitation in the absence of prospective data.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Review article: safety profile of propofol for paediatric procedural sedation in the emergency department

This review concluded that use of propofol for paediatric procedural sedation was associated with a low rate of minor adverse events and major adverse events with propofol sedation were extremely rare. These conclusions should be interpreted cautiously given concerns about the review methods and the possibility of publication and language biases.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

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