Association of End-Tidal Carbon Dioxide Monitoring With Nurses' Confidence in Patient Readiness for Postanesthesia Discharge.

PURPOSE: To determine if end-tidal carbon dioxide (etCO2) value increased nurses' perceptions of confidence in patients' readiness for postanesthesia care unit (PACU) discharge. DESIGN: Prospective, cross-sectional, comparative, one-group (pre-post) design. METHODS: Nurses completed 2 assessments of confidence in readiness for discharge, before and after etCO2 monitoring. Patient (discharge pain level, body mass index, sleep apnea history, and opioid use) and nurse factors were assessed. Analyses included descriptive and comparative statistics. FINDINGS: Of 133 patients, mean (standard deviation) etCO2 was 36.1 (5.7) mm Hg. Nurses' confidence in readiness for discharge differed before and after etCO2 assessment. Confidence score decreased when etCO2 was low (P = .003) or high (P = .005), compared with normal values. In linear regression, etCO2 remained a factor in nurses' confidence in readiness for discharge (P < .001). CONCLUSIONS: In a PACU, etCO2 monitoring changed nurses' perceptions of confidence in patients' readiness for discharge.

Experiences with capnography in acute care settings: a mixed-methods analysis of clinical staff.

PURPOSE: Although capnography is being incorporated into clinical guidelines, it is not used to its full potential. We investigated reasons for limited implementation of capnography in acute care areas and explored facilitators and barriers to its implementation. METHODS: A purposeful sample of physicians and nurses in emergency departments and intensive care units participated in semistructured interviews. Grounded theory, iterative data analysis, and the constant comparative method were used to analyze the data to inductively generate ideas and build theories. RESULTS: Nineteen providers were interviewed from 5 hospitals. Six themes were identified: variability in use of capnography among acute care units, availability and accessibility of capnography equipment, the evidence behind capnography use, the impact of capnography on patient care, personal experiences impacting use of capnography, and variable knowledge about capnography. Barriers and facilitators to use were found within each theme. CONCLUSIONS: We observed varied responsiveness to capnography and identified factors that work to foster or discourage its use. These data can guide future implementation strategies. A deliberate strategy to foster utilization, mitigate barriers, and broadly accelerate implementation has the potential to profoundly impact use of capnography in acute care areas with the goal of improving patient care.

Separation anxiety disorder in children: disorder-specific responses to experimental separation from the mother.

BACKGROUND: Separation anxiety disorder (SAD) is one of the most common anxiety disorders in childhood and is predictive of adult anxiety disorders, especially panic disorder. However, the disorder has seldom been studied and the attempt to distinguish SAD from other anxiety disorders with regard to psychophysiology has not been made. We expected exaggerated anxiety as well as sympathetic and respiratory reactivity in SAD during separation from the mother. METHOD: Participants were 49 children with a principal diagnosis of SAD, 21 clinical controls (CC) with a principal diagnosis of anxiety disorder other than SAD, and 39 healthy controls (HC) not meeting criteria for any current diagnosis. Analyses of covariance controlling for age were used to assess sympathetic and parasympathetic activation (preejection period and respiratory sinus arrhythmia) as well as cardiovascular (heart rate, mean arterial pressure, total peripheral resistance), respiratory (total breath time, minute ventilation, tidal volume, end-tidal CO(2) , respiratory variability), electrodermal, and self-report (anxiety, cognitions, symptoms) variables during baseline, 4-min separation from, and reunion with the mother. RESULTS: Children with a diagnosis of SAD were characterized by elevated self-reported anxiety responses to separation and increased sympathetic reactivity compared with CC and HC groups. The SAD group also displayed greater vagal withdrawal and higher reactivity in multiple cardiovascular, respiratory, and electrodermal measures compared with the HC group, while corresponding responses were less in the CC group and not significantly different from the other groups. CONCLUSIONS: Separation from the mother elicits greater autonomic, respiratory, and experiential responses in children with SAD. Our findings based on brief experimental separation demonstrate differential subjective and physiological manifestations of specific anxiety diagnoses, thus supporting the validity of the diagnostic category of SAD.