Capnography With Integrated Pulmonary Index for Preventing Hypoxemia During Pediatric Urologic Surgery Under Sedation: A Randomized Controlled Trial

Clinical Snapshot

Key Findings

• P Value: P=0.012

• Effect Size: Odds ratio 0.410 for hypoxemia prevention

• Primary Outcome: Intraoperative hypoxemia: 34.33% intervention vs 56.06% control

• Nnt Or Sensitivity: NNT = 5 (based on 21.73% absolute risk reduction)

• Confidence Interval: 95% CI: 0.203-0.825

Clinical Application

High feasibility - capnography and IPI monitoring equipment widely available in Australian hospitals Aligns with ANZCA guidelines for procedural sedation monitoring; technology covered under hospital equipment budgets; supports patient safety initiatives Children undergoing urologic procedures under procedural sedation in hospital settings

Abstract

BACKGROUND Procedural sedation and analgesia (PSA) can relieve pain and anxiety during invasive procedures. Carbon dioxide (CO₂) monitoring or integrated pulmonary index (IPI) can reduce respiratory depression in adults with PSA, but the effect of the combination of these 2 methods on intraoperative hypoxemia in pediatric urologic surgery is unclear. This study was conducted to determine whether capnography combined with IPI could lessen intraoperative hypoxemia during pediatric urinary procedures with PSA. MATERIAL AND METHODS We conducted a randomized controlled trial (ChiCTR 2300073943). Children referred for urinary procedures with PSA were randomly assigned to either a control group with standard monitoring or an intervention group with standard monitoring combined with capnography and IPI monitoring. The primary outcome was intraoperative hypoxemia. Secondary outcomes were severe intraoperative hypoxemia, airway management, and perioperative complications. RESULTS A total of 133 patients completed the analysis (67 in the intervention group and 66 in the control group). Compared with the control group, the incidence of intraoperative oxygen saturation decline was significantly lower in the intervention group (34.33% vs 56.06%, odds ratio=0.410, 95% confidence interval: 0.203-0.825, P=0.012). Simultaneously, the incidence of severe oxygen desaturation (SpO₂ <90%) was also significantly reduced in the intervention group (19.40% vs 36.40%, odds ratio=0.421, 95% confidence interval: 0.192-0.925, P=0.034). Regarding airway management interventions, the intervention group exhibited a higher frequency of jaw thrust maneuvers (1.84±1.31 vs 1.17±1.12 times, P=0.004) and a significantly reduced need for invasive positive-pressure ventilation (1.64±1.31 vs 2.39±1.48, P=0.002). No differences in other airway management techniques or perioperative complications were observed between the 2 groups. CONCLUSIONS The addition of capnography and IPI monitoring to standard monitoring reduces the risk of intraoperative hypoxemia in pediatric urologic surgery and reduces the need for aggressive ventilation through early intervention.

References

1. 1.Wang, Y., Liu, H., Yang, M., Hu, X., Yu, L., & Guo, H. (2026). Capnography with integrated pulmonary index for preventing hypoxemia during pediatric urologic surgery under sedation: A randomized controlled trial. Medical Science Monitor, Article 951900. https://doi.org/10.12659/MSM.951900