MT3 THE EFFECTIVENESS OF CAPNOGRAPHY ON CLINICALLY IMPORTANT OUTCOMES FROM OPIOID-INDUCED RESPIRATORY DEPRESSION: A LITERATURE REVIEW

Abstract

Undetected opioid-induced respiratory depression (OIRD) is a top ten health technology hazard. It can lead to anoxic brain injury and death. A systematic review showed that capnography detects OIRD better than pulse oximetry; however, the effectiveness of capnography on patient outcomes has not been reviewed. The objective of this study was to review the current state of knowledge on the effectiveness of capnography monitoring on clinically important outcomes. A systematic search of MEDLINE was conducted for literature published between 1946 and September 2018. The Boolean query (“analgesia” OR “patient-controlled analgesia” OR “opioid”) AND (“respiratory depression” OR “respiratory insufficiency” OR “drug overdose” OR “adverse event”) AND (“capnography”) was employed. Additional articles were identified through manual reviews of references. Studies were assessed for relevance, design, setting, and outcomes measured. Of the 56 studies identified, three were eligible for inclusion in the descriptive analysis. A retrospective analysis, of patients receiving PCA or deemed high-risk per clinicians, demonstrated that capnography significantly reduced incidence of OIRD requiring rapid response team activation (0.04% vs. 0.02%, p < 0.0001) and unplanned transfers to the ICU (7.6 transfers/month vs. 1.6 transfers/month). A case report, of patients ordered parenteral opioids and receiving supplemental oxygen, observed a 33% reduction in severe OIRD events (4.2 events/quarter vs. 2.8 events/quarter) post-implementation of capnography. Another case report, of medical-surgical patients deemed high-risk per clinicians, found that OIRD events resulting in respiratory arrest were eliminated after hospital initiatives increased uptake of capnography monitoring. Overall, continuous capnography increased patient safety with reductions in severe OIRD events, rapid response team activation, and transfers to higher levels of care. Capnography is associated with reductions in clinically important patient outcomes and associated healthcare utilization. Future research to develop a tool to systematically identify high-risk patients, that would benefit most from capnography monitoring, is needed.