Abstract
Although postoperative adverse respiratory events, defined by a decrease in respiratory rate (RR) and/or a drop in oxygen saturation (SpO2), occur frequently, many of such events are missed. The purpose of the current study was to assess whether continuous monitoring of the integrated pulmonary index (IPI), a composite index of SpO2, RR, end-tidal PCO2 and heart rate, alters our ability to identify and prevent adverse respiratory events in postoperative patients. Eighty postoperative patients were subjected to continuous respiratory monitoring during the first postoperative night using RR and pulse oximetry and the IPI monitor. Patients were randomized to receive intervention based on standard care (observational) or based on the IPI monitor (interventional). Nurses were asked to respond to adverse respiratory events with an intervention to improve the patient’s respiratory condition. There was no difference in the number of patients that experienced at least one adverse respiratory event: 21 and 16 in observational and interventional group, respectively (p = 0.218). Compared to the observational group, the use of the IPI monitor led to an increase in the number of interventions performed by nurses to improve the respiratory status of the patient (average 13 versus 39 interventions, p < 0.001). This difference was associated with a significant reduction of the median number of events per patient (2.5 versus 6, p < 0.05) and a shorter median duration of events (62 s versus 75 s, p < 0.001). The use of the IPI monitor in postoperative patients did not result in a reduction of the number of patients experiencing adverse respiratory events, compared to standard clinical care. However, it did lead to an increased number of nurse interventions and a decreased number and duration of respiratory events in patients that experienced postoperative adverse respiratory events.
Highlights
Several surgery and anesthesia-related factors increase the risk of an adverse respiratory event (ARE) in the perioperative period
We found that compared to continuous monitoring using respiratory rate and pulse oximetry alone, the use of the integrated pulmonary index (IPI) monitor led to an increase in the number of interventions performed by nurses to improve the respiratory condition of the patient
Observational, multicenter trial, patients receiving opioids for postoperative pain relief were monitored with the Capnostream monitor and separate signals were collected and analyzed
Summary
Several surgery and anesthesia-related factors increase the risk of an adverse respiratory event (ARE) in the perioperative period. Given the availability of effective interventions, these respiratory catastrophes following routine, elective surgery have been termed ‘never events’ in that they should never be allowed to occur [9]. The challenge is to predict or identify respiratory events and intervene before any further respiratory deterioration. Available scoring systems, such as the STOP-BANG questionnaire, which is based on patient-related risk factors, predict postoperative AREs poorly [10, 11]. Sun et al showed that prolonged episodes of hypoxemia are common in the first 48 h following non-cardiac surgery and that 90% of these events were missed by routine 4-hourly spot checks in the postoperative wards [15]. Lee et al showed that the time between the discovery of respiratory depression and the last nursing assessment was 2 h in 42% of the cases and a concerning 15 min in 13% of the cases [13]
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