human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : Hypopneic hypoventilation , a decrease in tidal volume without a change in respiratory rate , is not easily detected by st and ard monitoring practice s during sedation but can be detected by capnography . Our goal was to determine the frequency of hypopneic hypoventilation and its association with hypoxia in children undergoing sedation with ketamine .  Methods : Children who received intravenous ketamine with or without midazolam for sedation in a pediatric emergency department were prospect ively enrolled . Heart rate , respiratory rate , pulse oximetry , and end-tidal carbon dioxide ( ETCO2 ) levels were recorded every 30 seconds . Results : Fifty-eight subjects were included in this study . Fifty percent of subjects had recorded ETCO2 values less than 30 mm Hg without a rise in respiratory rate . Twenty-eight percent of subjects experienced a decrease in pulse oximetry less than 95 % . Patients who experienced a persistent decrease in ETCO2 at least 30 seconds in length were much more likely to have a persistent decrease in pulse oximetry than those with normal or transient decreases in ETCO2 ( relative risk , 6.6 ; 95 % confidence interval , 1.4 - 30.5 ) . Decreases in ETcO2 occurred on an average of 3.7 minutes before decreases in pulse oximetry . Conclusions : Hypopneic hypoventilation as detected by capnography is common in children undergoing sedation with ketamine with or without midazolam .  Hypoxia is frequently preceded by low ETCO2 levels . Further studies are needed to determine if the addition of routine monitoring with capnography can reduce the frequency of hypoxia in children undergoing sedation BACKGROUND Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea . OBJECTIVE To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage ( PTCD ) .  METHODS Twenty consecutive patients scheduled for PTCD were included in the study . All patients were se date d during the procedure using midazolam and propofol . Aside from st and ard monitoring , additional capnographic monitoring was used and analyzed by an independent observer . RESULTS The mean ( ± SD ) cumulative duration of apnea demonstrated by capnography was significantly longer than the mean cumulative duration of clinical ly detected apnea ( 207.5 ± 348.8 s versus 8.2 ± 17.9 s ; P=0.015 ) . The overall number of detected episodes of apnea was also significantly different ( 113 versus seven ; P=0.012 ) . There were 15 events of oxygen desaturation ( decrease in oxygen saturation [ SaO2 ] ≥ 5 % ) , which were predicted in eight of 15 cases by capnography and in one of 15 cases by clinical observation . There were three events of hypoxemia ( SaO2 < 90 % ) that were predicted in three of three cases by capnography and in one of three cases by clinical observation . CONCLUSION Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD BACKGROUND Transcutaneous measurement of carbon dioxide ( Tc(co(2 ) ) ) provides a non-invasive estimation of arterial carbon dioxide ( Pa(co(2 ) ) ) . Nasal capnography ( Pe'(co(2 ) ) ) is used to assess ventilation during monitored anaesthesia care ( MAC ) with sedation since it can readily detect apnoea . We compared the agreement between Tc(co(2 ) ) and Pe'(co(2 ) ) with Pa(co(2 ) ) and the ability to detect hypercarbia in patients under deep sedation . METHODS Forty healthy female subjects receiving deep sedation for hysteroscopy were studied . A Tc(co(2 ) ) ( TOSCA 500 , Radiometer , Inc. , Westlake , OH , USA ) electrode was applied to the earlobe and Pe'(co(2 ) ) capnography was monitored using nasal side-stream sampling . All subjects received oxygen ( 3 litre min(-1 ) ) . Subjects were evaluated at intervals using a modified Ramsay sedation score until they reached a score > or=5 . Arterial blood gas values were compared with Tc(co(2 ) ) and Pe'(co(2 ) ) values . Bl and -Altman , linear regression , and receiver operator characteristics analysis were performed . RESULTS The mean ( sd ) absolute difference between the Tc(co(2 ) ) , Pe'(co(2 ) ) , and the Pa(co(2 ) ) were 0.43 ( 0.35 ) and 1.06 ( 0.8 ) kPa , respectively ( P=0.002 ) . Tc(co(2 ) ) demonstrated a mean bias ( 2 sd ) of 0.23 ( 0.07 - 0.4 ) kPa with Pa(co(2 ) ) compared with -0.93 ( -1.24 to -0.63 ) kPa for Pe'(co(2 ) ) . One minute before blood sampling , the sensitivity of the Tc(co(2 ) ) monitor for detecting Pa(co(2 ) ) > 6.65 kPa was greater than for Pe'(co(2 ) ) ( 66.7 % vs 33.3 % , P<0.01 ) . CONCLUSIONS Tc(co(2 ) ) demonstrated better agreement with Pa(co(2 ) ) than Pe'(co(2 ) ) for patients under MAC with deep sedation . Tc(co(2 ) ) monitoring was more sensitive for detection of Pa(co(2 ) ) > 6.65 kPa than Pe'(co(2 ) ) Abstract Objective . St and ard benzodiazepine/opioid cocktail has proven inferior to propofol sedation during complicated endoscopic procedures and in low-tolerance patients . Propofol is a short-acting hypnotic with a potential risk of respiratory depression at levels of moderate to deep sedation . The existing literature on capnography for endoscopy patients se date d with nurse-administered propofol sedation ( NAPS ) is limited . Can the addition of capnography to st and ard monitoring during endoscopy with NAPS reduce the number , duration , and level of hypoxia . Material s and methods . This study was a r and omized controlled trial with an intervention group ( capnography ) and a control group ( without capnography ) . Eligible subjects were consecutive patients for endoscopy at Gentofte Hospital compliant with the criteria of NAPS . Results . Five hundred and forty patients , 263 with capnography and 277 without capnography , were included in the analysis . The number and total duration of hypoxia was reduced by 39.3 % and 21.1 % in the intervention group compared to the control group ( p > 0.05 ) . No differences in actions taken against insufficient respiration were found . Changes in end-tidal carbon dioxide ( R = 0.177 , p-value < 0.001 ) and respiratory rate ( R = 0.092 , p-value < 0.001 ) were correlated to oxygen saturation ( SpO2 ) up to 36 s prior to changes in SpO2 . Conclusions . Capnography seems to reduce the number and duration of hypoxia in NAPS patients ( p > 0.05 ) . Capnography is able to detect insufficient respiration that may lead to hypoxia prior to changes in pulse oximetry . However , due to a limited clinical benefit and additional costs associated with capnography , we do not find capnography necessary during the use of NAPS OBJECTIVE Data suggest that capnography is a more sensitive measure of ventilation than st and ard modalities and detects respiratory depression before hypoxemia occurs . We sought to determine if adding capnography to st and ard monitoring during sedation of children increased the frequency of interventions for hypoventilation , and whether these interventions would decrease the frequency of oxygen desaturations . METHODS We enrolled 154 children receiving procedural sedation in a pediatric emergency department . All subjects received st and ard monitoring and capnography , but were r and omized to whether staff could view the capnography monitor ( intervention ) or were blinded to it ( controls ) . Primary outcome were the rate of interventions provided by staff for hypoventilation and the rate of oxygen desaturation less than 95 % . RESULTS Seventy-seven children were r and omized to each group . Forty-five percent had at least 1 episode of hypoventilation . The rate of hypoventilation per minute was significantly higher among controls ( 7.1 % vs 1.0 % , P = .008 ) . There were significantly fewer interventions in the intervention group than in the control group ( odds ratio , 0.25 ; 95 % confidence interval [ CI ] , 0.13 - 0.50 ) . Interventions were more likely to occur contemporaneously with hypoventilation in the intervention group ( 2.26 ; 95 % CI , 1.34 - 3.81 ) . Interventions not in time with hypoventilation were associated with higher odds of oxygen desaturation less than 95 % ( odds ratio , 5.31 ; 95 % CI , 2.76 - 10.22 ) . CONCLUSION Hypoventilation is common during sedation of pediatric emergency department patients . This can be difficult to detect by current monitoring methods other than capnography . Providers with access to capnography provided fewer but more timely interventions for hypoventilation . This led to fewer episodes of hypoventilation and of oxygen desaturation BACKGROUND AND STUDY AIMS Capnography enables the measurement of end-tidal CO2 and thereby the early detection of apnea , prompting immediate intervention to restore ventilation . Studies have shown that capnographic monitoring is associated with a reduction of hypoxemia during sedation for endoscopy and early detection of apnea during sedation for colonoscopy . The primary aim of this prospect i ve r and omized study was to evaluate whether capnographic monitoring without tracheal intubation reduces hypoxemia during propofol-based sedation in patients undergoing colonoscopy . PATIENTS AND METHODS A total of 533 patients presenting for colonoscopy at two study sites were r and omized to either st and ard monitoring ( n = 266 ) or to st and ard monitoring with capnography ( n = 267 ) . The incidence of hypoxemia ( SO2 < 90 % ) and severe hypoxemia ( SO2 < 85 % ) were compared between the groups . Furthermore , risk factors for hypoxemia were evaluated , and sedation performed by anesthesiologists was compared with nurse-administered propofol sedation ( NAPS ) or endoscopist-directed sedation ( EDS ) . RESULTS The incidence of hypoxemia was significantly lower in patients with capnography monitoring compared with those receiving st and ard monitoring ( 18 % vs. 32 % ; P = 0.00091 ) . Independent risk factors for hypoxemia were age ( P = 0.00015 ) , high body mass index ( P = 0.0044 ) , history of sleep apnea ( P = 0.025 ) , st and ard monitoring group ( P = 0.000069 ) , total dose of propofol ( P = 0.031 ) , and dose of ketamine ( P < 0.000001 ) . Patients receiving anesthesiologist-administered sedation developed hypoxemic events more often than those receiving NAPS or EDS . In patients with anesthesiologist-administered sedation , sedation was deeper , a combination of sedative medication ( propofol , midazolam and /or ketamine ) was administered significantly more often , and sedative doses were significantly higher compared with patients receiving NAPS or EDS . CONCLUSIONS In patients undergoing colonoscopy during propofol-based sedation capnography monitoring with a simple and inexpensive device reduced the incidence of hypoxemia OBJECTIVE Important questions remain regarding how best to monitor patients during procedural sedation and analgesia ( PSA ) .  Capnometry can detect hypoventilation and apnea , yet it is rarely used in emergency patients . Even the routine practice of performing preoxygenation in low-risk patients is controversial , as supplementary oxygen can delay the detection of respiratory depression by pulse oximetry . The purpose of this study was to determine whether the capnometer or the pulse oximeter would first detect respiratory events in adults breathing room air . METHODS During a r and omized clinical trial comparing fentanyl with low-dose ketamine for PSA with titrated propofol , patients were monitored using pulse oximetry and continuous oral-nasal sample d capnography . Supplemental oxygen was administered only for oxygen desaturation . Sedating physicians identified prespecified respiratory events , including hypoventilation ( end-tidal carbon dioxide > 50 mm Hg , rise of 10 mm Hg from baseline or loss of waveform ) and oxygen desaturation ( pulse oximetry < 92 % ) . These events and their timing were corroborated by memory data retrieved from the monitors . RESULTS Of 63 patients enrolled , 57 % ( 36 ) developed brief oxygen desaturation at some point during the sedation . All responded to oxygen , stimulation or interruption of propofol . Measurements of end-tidal carbon dioxide varied substantially between and within patients before study intervention . Hypoventilation ( 19 patients , 30 % ) was only weakly associated with oxygen desaturation ( crude odds ratio 1.4 [ 95 % confidence interval 0.47 to 4.3 ] ) , and preceded oxygen desaturation in none of the 12 patients in whom both events occurred ( median lag 1:50 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives : Hypopneic hypoventilation , a decrease in tidal volume without a change in respiratory rate , is not easily detected by st and ard monitoring practice s during sedation but can be detected by capnography . Our goal was to determine the frequency of hypopneic hypoventilation and its association with hypoxia in children undergoing sedation with ketamine .  Methods : Children who received intravenous ketamine with or without midazolam for sedation in a pediatric emergency department were prospect ively enrolled . Heart rate , respiratory rate , pulse oximetry , and end-tidal carbon dioxide ( ETCO2 ) levels were recorded every 30 seconds . Results : Fifty-eight subjects were included in this study . Fifty percent of subjects had recorded ETCO2 values less than 30 mm Hg without a rise in respiratory rate . Twenty-eight percent of subjects experienced a decrease in pulse oximetry less than 95 % . Patients who experienced a persistent decrease in ETCO2 at least 30 seconds in length were much more likely to have a persistent decrease in pulse oximetry than those with normal or transient decreases in ETCO2 ( relative risk , 6.6 ; 95 % confidence interval , 1.4 - 30.5 ) . Decreases in ETcO2 occurred on an average of 3.7 minutes before decreases in pulse oximetry . Conclusions : Hypopneic hypoventilation as detected by capnography is common in children undergoing sedation with ketamine with or without midazolam .  Hypoxia is frequently preceded by low ETCO2 levels . Further studies are needed to determine if the addition of routine monitoring with capnography can reduce the frequency of hypoxia in children undergoing sedation BACKGROUND Capnography provides noninvasive monitoring of ventilation and can enable early recognition of altered respiration patterns and apnea . OBJECTIVE To compare the detection of apnea and the prediction of oxygen desaturation and hypoxemia using capnography versus clinical surveillance during procedural sedation for percutaneous transhepatic cholangiodrainage ( PTCD ) .  METHODS Twenty consecutive patients scheduled for PTCD were included in the study . All patients were se date d during the procedure using midazolam and propofol . Aside from st and ard monitoring , additional capnographic monitoring was used and analyzed by an independent observer . RESULTS The mean ( ± SD ) cumulative duration of apnea demonstrated by capnography was significantly longer than the mean cumulative duration of clinical ly detected apnea ( 207.5 ± 348.8 s versus 8.2 ± 17.9 s ; P=0.015 ) . The overall number of detected episodes of apnea was also significantly different ( 113 versus seven ; P=0.012 ) . There were 15 events of oxygen desaturation ( decrease in oxygen saturation [ SaO2 ] ≥ 5 % ) , which were predicted in eight of 15 cases by capnography and in one of 15 cases by clinical observation . There were three events of hypoxemia ( SaO2 < 90 % ) that were predicted in three of three cases by capnography and in one of three cases by clinical observation . CONCLUSION Capnographic monitoring was superior to clinical surveillance in the detection of apnea and in the prediction of oxygen desaturation during procedural sedation for PTCD BACKGROUND Transcutaneous measurement of carbon dioxide ( Tc(co(2 ) ) ) provides a non-invasive estimation of arterial carbon dioxide ( Pa(co(2 ) ) ) . Nasal capnography ( Pe'(co(2 ) ) ) is used to assess ventilation during monitored anaesthesia care ( MAC ) with sedation since it can readily detect apnoea . We compared the agreement between Tc(co(2 ) ) and Pe'(co(2 ) ) with Pa(co(2 ) ) and the ability to detect hypercarbia in patients under deep sedation . METHODS Forty healthy female subjects receiving deep sedation for hysteroscopy were studied . A Tc(co(2 ) ) ( TOSCA 500 , Radiometer , Inc. , Westlake , OH , USA ) electrode was applied to the earlobe and Pe'(co(2 ) ) capnography was monitored using nasal side-stream sampling . All subjects received oxygen ( 3 litre min(-1 ) ) . Subjects were evaluated at intervals using a modified Ramsay sedation score until they reached a score > or=5 . Arterial blood gas values were compared with Tc(co(2 ) ) and Pe'(co(2 ) ) values . Bl and -Altman , linear regression , and receiver operator characteristics analysis were performed . RESULTS The mean ( sd ) absolute difference between the Tc(co(2 ) ) , Pe'(co(2 ) ) , and the Pa(co(2 ) ) were 0.43 ( 0.35 ) and 1.06 ( 0.8 ) kPa , respectively ( P=0.002 ) . Tc(co(2 ) ) demonstrated a mean bias ( 2 sd ) of 0.23 ( 0.07 - 0.4 ) kPa with Pa(co(2 ) ) compared with -0.93 ( -1.24 to -0.63 ) kPa for Pe'(co(2 ) ) . One minute before blood sampling , the sensitivity of the Tc(co(2 ) ) monitor for detecting Pa(co(2 ) ) > 6.65 kPa was greater than for Pe'(co(2 ) ) ( 66.7 % vs 33.3 % , P<0.01 ) . CONCLUSIONS Tc(co(2 ) ) demonstrated better agreement with Pa(co(2 ) ) than Pe'(co(2 ) ) for patients under MAC with deep sedation . Tc(co(2 ) ) monitoring was more sensitive for detection of Pa(co(2 ) ) > 6.65 kPa than Pe'(co(2 ) ) Abstract Objective . St and ard benzodiazepine/opioid cocktail has proven inferior to propofol sedation during complicated endoscopic procedures and in low-tolerance patients . Propofol is a short-acting hypnotic with a potential risk of respiratory depression at levels of moderate to deep sedation . The existing literature on capnography for endoscopy patients se date d with nurse-administered propofol sedation ( NAPS ) is limited . Can the addition of capnography to st and ard monitoring during endoscopy with NAPS reduce the number , duration , and level of hypoxia . Material s and methods . This study was a r and omized controlled trial with an intervention group ( capnography ) and a control group ( without capnography ) . Eligible subjects were consecutive patients for endoscopy at Gentofte Hospital compliant with the criteria of NAPS . Results . Five hundred and forty patients , 263 with capnography and 277 without capnography , were included in the analysis . The number and total duration of hypoxia was reduced by 39.3 % and 21.1 % in the intervention group compared to the control group ( p > 0.05 ) . No differences in actions taken against insufficient respiration were found . Changes in end-tidal carbon dioxide ( R = 0.177 , p-value < 0.001 ) and respiratory rate ( R = 0.092 , p-value < 0.001 ) were correlated to oxygen saturation ( SpO2 ) up to 36 s prior to changes in SpO2 . Conclusions . Capnography seems to reduce the number and duration of hypoxia in NAPS patients ( p > 0.05 ) . Capnography is able to detect insufficient respiration that may lead to hypoxia prior to changes in pulse oximetry . However , due to a limited clinical benefit and additional costs associated with capnography , we do not find capnography necessary during the use of NAPS OBJECTIVE Data suggest that capnography is a more sensitive measure of ventilation than st and ard modalities and detects respiratory depression before hypoxemia occurs . We sought to determine if adding capnography to st and ard monitoring during sedation of children increased the frequency of interventions for hypoventilation , and whether these interventions would decrease the frequency of oxygen desaturations . METHODS We enrolled 154 children receiving procedural sedation in a pediatric emergency department . All subjects received st and ard monitoring and capnography , but were r and omized to whether staff could view the capnography monitor ( intervention ) or were blinded to it ( controls ) . Primary outcome were the rate of interventions provided by staff for hypoventilation and the rate of oxygen desaturation less than 95 % . RESULTS Seventy-seven children were r and omized to each group . Forty-five percent had at least 1 episode of hypoventilation . The rate of hypoventilation per minute was significantly higher among controls ( 7.1 % vs 1.0 % , P = .008 ) . There were significantly fewer interventions in the intervention group than in the control group ( odds ratio , 0.25 ; 95 % confidence interval [ CI ] , 0.13 - 0.50 ) . Interventions were more likely to occur contemporaneously with hypoventilation in the intervention group ( 2.26 ; 95 % CI , 1.34 - 3.81 ) . Interventions not in time with hypoventilation were associated with higher odds of oxygen desaturation less than 95 % ( odds ratio , 5.31 ; 95 % CI , 2.76 - 10.22 ) . CONCLUSION Hypoventilation is common during sedation of pediatric emergency department patients . This can be difficult to detect by current monitoring methods other than capnography . Providers with access to capnography provided fewer but more timely interventions for hypoventilation . This led to fewer episodes of hypoventilation and of oxygen desaturation BACKGROUND AND STUDY AIMS Capnography enables the measurement of end-tidal CO2 and thereby the early detection of apnea , prompting immediate intervention to restore ventilation . Studies have shown that capnographic monitoring is associated with a reduction of hypoxemia during sedation for endoscopy and early detection of apnea during sedation for colonoscopy . The primary aim of this prospect i ve r and omized study was to evaluate whether capnographic monitoring without tracheal intubation reduces hypoxemia during propofol-based sedation in patients undergoing colonoscopy . PATIENTS AND METHODS A total of 533 patients presenting for colonoscopy at two study sites were r and omized to either st and ard monitoring ( n = 266 ) or to st and ard monitoring with capnography ( n = 267 ) . The incidence of hypoxemia ( SO2 < 90 % ) and severe hypoxemia ( SO2 < 85 % ) were compared between the groups . Furthermore , risk factors for hypoxemia were evaluated , and sedation performed by anesthesiologists was compared with nurse-administered propofol sedation ( NAPS ) or endoscopist-directed sedation ( EDS ) . RESULTS The incidence of hypoxemia was significantly lower in patients with capnography monitoring compared with those receiving st and ard monitoring ( 18 % vs. 32 % ; P = 0.00091 ) . Independent risk factors for hypoxemia were age ( P = 0.00015 ) , high body mass index ( P = 0.0044 ) , history of sleep apnea ( P = 0.025 ) , st and ard monitoring group ( P = 0.000069 ) , total dose of propofol ( P = 0.031 ) , and dose of ketamine ( P < 0.000001 ) . Patients receiving anesthesiologist-administered sedation developed hypoxemic events more often than those receiving NAPS or EDS . In patients with anesthesiologist-administered sedation , sedation was deeper , a combination of sedative medication ( propofol , midazolam and /or ketamine ) was administered significantly more often , and sedative doses were significantly higher compared with patients receiving NAPS or EDS . CONCLUSIONS In patients undergoing colonoscopy during propofol-based sedation capnography monitoring with a simple and inexpensive device reduced the incidence of hypoxemia OBJECTIVE Important questions remain regarding how best to monitor patients during procedural sedation and analgesia ( PSA ) .  Capnometry can detect hypoventilation and apnea , yet it is rarely used in emergency patients . Even the routine practice of performing preoxygenation in low-risk patients is controversial , as supplementary oxygen can delay the detection of respiratory depression by pulse oximetry . The purpose of this study was to determine whether the capnometer or the pulse oximeter would first detect respiratory events in adults breathing room air . METHODS During a r and omized clinical trial comparing fentanyl with low-dose ketamine for PSA with titrated propofol , patients were monitored using pulse oximetry and continuous oral-nasal sample d capnography . Supplemental oxygen was administered only for oxygen desaturation . Sedating physicians identified prespecified respiratory events , including hypoventilation ( end-tidal carbon dioxide > 50 mm Hg , rise of 10 mm Hg from baseline or loss of waveform ) and oxygen desaturation ( pulse oximetry < 92 % ) . These events and their timing were corroborated by memory data retrieved from the monitors . RESULTS Of 63 patients enrolled , 57 % ( 36 ) developed brief oxygen desaturation at some point during the sedation . All responded to oxygen , stimulation or interruption of propofol . Measurements of end-tidal carbon dioxide varied substantially between and within patients before study intervention . Hypoventilation ( 19 patients , 30 % ) was only weakly associated with oxygen desaturation ( crude odds ratio 1.4 [ 95 % confidence interval 0.47 to 4.3 ] ) , and preceded oxygen desaturation in none of the 12 patients in whom both events occurred ( median lag 1:50 
    Output:
    