e5ddf90b585b3a0c4247a9a10a02b1bd 326789.pdf c171ad03de3717421650682b31914f01cbb86668 326789.pdf 676c0bba029a1b69320b89381e70bd115751c7898496447c6ec6cc4f15a5c8ad 326789.pdf Title: Non-Invasive Capnography Versus Pulse Oximetry for Early Detection of Respiratory Depression During Pediatric Procedural Sedation: A Prospective Observational Study Subject: Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational study evaluated the diagnostic accuracy of non-invasive capnography, compared to pulse oximetry, for detecting respiratory depression in pediatric patients undergoing sedation. Methods: We conducted a single-center, prospective observational study at a tertiary pediatric hospital, enrolling 101 patients (ages 1–17 years) undergoing sedation for diagnostic or therapeutic procedures. Patients were monitored using both pulse oximetry and non-invasive capnography. Episodes of respiratory depression—defined as apnea, hypopneic hypoventilation, bradypneic hypoventilation, and desaturation—were recorded. We compared the diagnostic performance and time to detection between capnography and pulse oximetry. Results: We identified 93 episodes of respiratory depression in 52 patients (51.1%). Capnography detected all apnea episodes and 76.9% of hypopneic hypoventilation episodes that were not identified by pulse oximetry. The median time advantage of capnography over pulse oximetry was 35 s (p = 0.0055). Combining capnography and pulse oximetry identified more events than pulse oximetry alone (93 vs. 53 episodes). Conclusions: Non-invasive capnography improves the early detection of respiratory depression compared to conventional monitoring with pulse oximetry in pediatric procedural sedation. While these findings support its routine use to enhance patient safety, larger multicenter studies are needed to demonstrate its diagnostic accuracy and impact on clinical outcomes. Keywords: pediatric sedation; capnography; respiratory monitoring; respiratory depression; procedural sedation Author: Laura Català Altarriba, Sean Yeh Hsi, Aude Marie Ravit, Sònia Brió Sanagustín and Xoan González-Rioja Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25; modified using OpenPDF 1.4.2 CreationDate: Fri Jul 18 08:10:15 2025 CEST ModDate: Fri Jul 18 08:15:54 2025 CEST Custom Metadata: yes Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 12 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 449192 bytes Optimized: no PDF version: 1.5 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- FFWQTS+URWPalladioL-Ital Type 1 Custom yes yes yes 154 0 FMHSVG+VnURWPalladioL Type 1 Custom yes yes yes 155 0 KGSVEK+VnURWPalladioL-Bold Type 1 Custom yes yes yes 156 0 WKCOTS+URWPalladioL-Bold Type 1 Custom yes yes yes 157 0 HPZDBT+URWPalladioL-Roma Type 1 Custom yes yes yes 158 0 VDITSV+CMSY10 Type 1 Builtin yes yes yes 243 0 WPQCLC+wasy10 Type 1 Builtin yes yes yes 291 0 CIDFont+F2 CID TrueType Identity-H yes no yes 328 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2026-03-19 04:08:20 CET RepresentationInformation: 326789.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2026-03-18 12:17:15 CET Size: 449192 Format: PDF Version: 1.5 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 516 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: ViewerPreferences: HideToolbar: false HideMenubar: false HideWindowUI: false FitWindow: true CenterWindow: false DisplayDocTitle: false NonFullScreenPageMode: UseNone Direction: L2R ViewArea: CropBox ViewClip: CropBox PrintArea: CropBox PageClip: CropBox PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Item: Title: Materials and Methods Children: Item: Title: Study Design Item: Title: Participants Item: Title: Sedation and Monitoring Protocol Children: Item: Title: Monitoring Item: Title: Evaluation Scales Item: Title: Definition of Respiratory Events Item: Title: Sample Size and Power Analysis Item: Title: Statistical Analysis Item: Title: Results Children: Item: Title: Patient Characteristics Item: Title: Sedation and Pain Scores Item: Title: Respiratory Depression Events Children: Item: Title: Hypopneic Hypoventilation: 52 Episodes in 35 Patients Item: Title: Isolated Bradypneic Hypoventilation: 0 Episodes Item: Title: Isolated Desaturation: 32 Episodes in 21 Patients Item: Title: Apnea: 9 Episodes, All Detected Early by Capnography Item: Title: Time Difference Analysis Item: Title: Clinical Interventions Item: Title: ASA Classification Item: Title: Discussion Children: Item: Title: Study Limitations Item: Title: Clinical Implications and Future Directions Item: Title: Conclusions Item: Title: References Info: Title: Non-Invasive Capnography Versus Pulse Oximetry for Early Detection of Respiratory Depression During Pediatric Procedural Sedation: A Prospective Observational Study Author: Laura Català Altarriba, Sean Yeh Hsi, Aude Marie Ravit, Sònia Brió Sanagustín and Xoan González-Rioja Subject: Background/Objectives: Continuous ventilation monitoring during pediatric sedation is essential, as respiratory depression may occur silently and may not be detected promptly by conventional methods such as pulse oximetry. Non-invasive capnography has been proposed to improve early detection of respiratory compromise. This prospective observational study evaluated the diagnostic accuracy of non-invasive capnography, compared to pulse oximetry, for detecting respiratory depression in pediatric patients undergoing sedation. Methods: We conducted a single-center, prospective observational study at a tertiary pediatric hospital, enrolling 101 patients (ages 1–17 years) undergoing sedation for diagnostic or therapeutic procedures. Patients were monitored using both pulse oximetry and non-invasive capnography. Episodes of respiratory depression—defined as apnea, hypopneic hypoventilation, bradypneic hypoventilation, and desaturation—were recorded. We compared the diagnostic performance and time to detection between capnography and pulse oximetry. Results: We identified 93 episodes of respiratory depression in 52 patients (51.1%). Capnography detected all apnea episodes and 76.9% of hypopneic hypoventilation episodes that were not identified by pulse oximetry. The median time advantage of capnography over pulse oximetry was 35 s (p = 0.0055). Combining capnography and pulse oximetry identified more events than pulse oximetry alone (93 vs. 53 episodes). Conclusions: Non-invasive capnography improves the early detection of respiratory depression compared to conventional monitoring with pulse oximetry in pediatric procedural sedation. While these findings support its routine use to enhance patient safety, larger multicenter studies are needed to demonstrate its diagnostic accuracy and impact on clinical outcomes. 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