Frequent respiratory events in postoperative patients aged 60 years and above

Abstract

There is limited information on the occurrence of respiratory events in postoperative patients after discharge from the postanesthesia care unit. We studied the respiratory rate (RR) of 68 patients aged 60 years and above during the first 6 hours following elective surgery under general anesthesia to assess the frequency of respiratory events in the care unit and on the ward. RR was derived from the continuous RR counter RespiR8, measuring RR by quantifying the humidity of exhaled air. One-minute-averaged RRs were collected and analyzed to assess the frequency of postoperative bradypnea (RR 1–6 breaths/minute) and apnea (cessation of inspiratory flow ≥60 seconds). Values were median (interquartile range) or mean (SD). The median RR was 13 (10–15) breaths/minute. In the 6-hour postoperative period, 78% and 57% of patients experienced at least one bradypnea or apnea event, respectively. A median of ten (3.5–24) bradypnea and three (1–11) apnea events were detected per patient. The occurrence of respiratory events in the postanesthesia care unit (PACU) was a predictor of events on the ward (bradypnea, r2=0.4, P<0.001; apnea, r2=0.2, P<0.001). Morphine consumption correlated weakly with respiratory events in the PACU, but not on the ward. Patients with apnea had significantly larger neck circumference than patients without (39.6 [0.7] versus 37.4 [0.8] cm, P<0.05). Bradypneic or apneic respiratory events are frequent in postoperative elderly patients and even occur relatively late after surgery. Continuous respiratory monitoring on the ward, especially in patients with risk factors, such as early occurrence of events, opioid use, and larger neck circumference, is likely warranted.

Postoperative respiratory state assessment using the Integrated Pulmonary Index (IPI) and resultant nurse interventions in the post-anesthesia care unit: a randomized controlled trial

“…We observed that patients receiving respiratory intervention based on the IPI monitor had less and shorter adverse respiratory events, compared to control patients. We expect the benefit of the IPI monitor to be higher on the general surgical ward, where opioids are given, respiratory events can occur but clinical monitoring is infrequent[ 22 ].…”

Estimating Respiratory Rate in Post-Anesthesia Care Unit Patients Using Infrared Thermography: An Observational Study

“…Because the assessment of BR was only conducted at one defined time point, and several measures were obtained from IRT sequence analysis, correlation was impaired for irregular breathing ( Table 3 ). Broens et al claimed that ECG-derived BR monitoring is error-prone and might lead to underdetection of respiratory events [ 6 ]. In addition, it is very prone to motion artefacts, poor electrode placement, and physiologic events that induce thoracic movements unrelated to respiration (e.g., coughing) [ 25 ].…”

“…Therefore, early detection of these CREs is very important for a prompt and appropriate medical intervention, such as a physical treatment (e.g., insertion of an oral or nasal supraglottic airway device, oxygen insufflation, or even tracheal reintubation) or pharmacological therapy (e.g., opioid antagonism or muscle relaxant reversal) [ 3 , 4 ]. In addition, the monitoring of breathing function is essential because altered breathing patterns such as tachypnea (high BR), bradypnea (low BR), apnea (suspension of breathing), or irregular breathing (e.g., Cheyne–Stokes respiration or Kussmaul breathing) may indicate impaired recovery [ 4 , 5 , 6 , 7 ]. For these reasons, BR and other vital parameters, such as heart rate and temperature, should be assessed continuously in PACUs.…”

Wearable Cardiorespiratory Monitoring Employing a Multimodal Digital Patch Stethoscope: Estimation of ECG, PEP, LVET and Respiration Using a 55 mm Single-Lead ECG and Phonocardiogram

“…Respiratory parameters also play an important role in the clinical, postanesthetic routine. It has been shown that respiratory complications are major causes of prolonged hospital stay, poor overall outcomes, and increased mortality [5][6][7]. Outbreaks of respiratory syndromes such as severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and the currently ongoing COVID-19 pandemic [8] further emphasize the importance of tools for an early diagnosis [9].…”