Continuous Capnography Reduces the Incidence of Opioid-Induced Respiratory Rescue by Hospital Rapid Resuscitation Team

Abstract

The aim of this study was to determine the impact of end tidal carbon dioxide or capnography monitoring in patients requiring patientcontrolled analgesia (PCA) on the incidence of opioid-induced respiratory depression (OIRD) in the setting of rapid response.Methods: A retrospective analysis was conducted in an urban tertiary care facility on the incidence of OIRD in the setting of rapid response as defined by a positive response to naloxone from January 2012 to December 2015. In March 2013, continuous capnography monitoring was implemented for all patients using PCA. Results:The preintervention incidence of OIRD in the setting of rapid response was 0.4% of patients receiving opioids. After the implementation of capnography, the incidence of OIRD in the setting of rapid response was reduced to 0.2%, which was statistically significant (χ 2 = 46.246; df, 1; P < 0.0001). The rate of transfers to a higher level of care associated with these events was also reduced by 79% (baseline, 7.6 transfers/month; postintervention, 1.6 transfers/month). Conclusions: Continuous capnography monitoring in patients receivingPCA significantly reduces the incidence of OIRD in the setting of rapid response and unplanned transfers to a higher level of care.

Prospective randomised trial of the Integrated Pulmonary Index™ in low-acuity inpatients

“…1 Fracture is a composite of osteoporosis, and other factors, such as falling, are also common in COPD. 3 Previously, worse outcomes have been demonstrated after hip fracture in patients with COPD. However, interpretation is limited because of data that are not contemporaneous, 4,5 poorly generalisable, 5 with limited follow-up, 6 or where confounders could not be comprehensively accounted for.…”

“…1 Whilst oxygen saturation (SpO 2 ) has been the mainstay of respiratory monitoring since the early 1980s, 2 end-tidal capnography (EtCO 2 ) may be superior to pulse oximetry in detecting respiratory compromise in patients receiving supplemental oxygen, even in low-acuity areas. 3,4 However, EtCO 2 monitoring has been largely limited to the operating room, procedural areas, and the ICU, partially out of concern that additional surveillance monitoring of inpatients may present interpretation difficulties for providers in low-acuity areas, whilst increasing alarm fatigue. 4 To address these concerns, the Integrated Pulmonary Index (IPI™, Medtronic, Dublin, Ireland) integrates four parametersdEtCO 2 , ventilatory frequency (VF), SpO 2 , and pulse rate (PR)dinto one unitless score.…”

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

“…There is strong evidence (category B-1) that the incidence of opioid-related adverse events such as OIRD is highest in the first postoperative 24 hours (Epstein, Dexter, Lopez, & Ehrenfeld, 2014;Lee et al, 2015;Rosenfeld et al, 2016;Weingarten, Herasevich, et al, 2015). There is also moderate quality evidence (category B-2) that increasing vigilance from every 4 hours to using continuous monitoring or assessments to every 2.5 hours during the first 24 hours will decrease the use of naloxone and rapid response team calls (Adams, Butas, & Spurlock, 2015;Jungquist et al, 2016;Lam et al, 2017;Stites, Surprise, McNiel, Northrop, & De Ruyter, 2017).…”

“…Values >50 represent carbon dioxide retention/respiratory insufficiency. Monitoring with capnography has been found to significantly reduce the incidence of OIUAS and OIRD with patient-controlled analgesia (PCA) by 79% as measured by decreased rapid response team (p < .001) and rate of transfers to a higher level of care (Stites et al, 2017). Barriers to the use of capnography on general care units are lack of nursing knowledge of the device and interpretation of ETCO 2 levels, cost, availability of equipment, and patient adherence (Carlisle, 2015;Langhan, Kurtz, Schaeffer, Asnes, & Riera, 2014).…”

“…Clinicians need ongoing education to ensure full understanding of the importance of pain, sedation, and respiratory assessments; which tools and assessment criteria are to be used; and how to most effectively intervene when sedation progresses and/or respiratory function is compromised (e.g., rapid response, transfer to higher level of care, code blue) at the organization where they are employed. Some facilities that have instituted continuous monitoring have published their procedures and outcomes to aid other facilities in the implementation of monitoring practices (Carlisle, 2015;Stites et al, 2017;Supe et al, 2017;van Loon, van Zaane, Bosch, Kalkman, & Peelen, 2015).…”