Abstract 9423: Acute Illness is a Risk Factor for Impaired Respiratory Function during Nurse-administered Procedural Sedation and Analgesia in the Cardiac Catheterization Laboratory

Abstract

Introduction Impaired respiratory function (IRF) during procedural sedation and analgesia (PSA) poses considerable risk to patient safety as it can lead to inadequate oxygenation and ventilation. Risk factors that can be screened prior to the procedure have not been identified for the cardiac catheterization laboratory (CCL).

Methods A matched case-control design was used. Clinical information from two hospitals, one public and one private, was abstracted from 573 medical records of those undergoing procedures in a CCL. IRF was defined as SpO2<95% or less than 8 respirations per minute. To control for potential intra-procedural confounders, those who also received nurse-administered PSA were matched based on the type of procedure as well as age and gender. Factors with significance p<0.10 on univariate analyses were entered into a backward stepwise conditional logistic regression model.

Results Nurses administered PSA during 252 procedures (44%). IRF occurred during 8.3% (95%CI=4.9%-11.7%) of these procedures (n=21). The 21 cases were matched with 113 controls. According to the regression model, with each additional indicator of acute illness, patients were nearly two times more likely than their controls to experience impaired respiratory function during nurse-administered PSA in the CCL (Table). Indicators of acute illness included emergency admission, transfer from critical care unit and requiring respiratory or haemodynamic support in the lead up to the procedure.

Conclusion The finding that patients with acute illness were most likely to have IRF during PSA has considerable face validity as it is probable these patients had underlying conditions impacting on their cardiopulmonary function. This significant risk needs to be addressed in practice. Nurses should be proactive when managing this group of patients, recognising the increased likelihood for respiratory impairment and applying intensive respiratory monitoring.