Respiratory Monitoring in General Care Units

Abstract

Respiratory compromise is a common and potentially dangerous complication of patients admitted to general care units of hospitals. There are several distinct and disparate pathophysiologic trajectories of respiratory deterioration that hospitalized patients may suffer. Obstructive sleep apnea and preexisting cardiopulmonary disease increase the risk of respiratory failure after major surgery. Patients in general care units of hospitals currently receive only intermittent monitoring of vital signs. Early warning systems that utilize analysis of intermittently collected vital signs may result in earlier recognition of clinical deterioration. Continuous monitoring of oximetry and capnography may allow the detection of pathophysiologic abnormalities earlier in patients in general care units, but the evidence for improved clinical outcomes remains weak. Increased monitoring may lead to increased monitor alarms that can have negative effects on patient care.

Respiration monitoring in PACU using ventilation and gas exchange parameters

“…The incidence of respiratory compromise in the general care units as well as PACU could be prevented or reduced by clinicians’ timely interventions aided by an early warning system based on continuous respiration monitoring 3 – 5 . Recent advances in impedance plethysmography 16 – 21 and EIT 24 – 30 have opened up opportunities for perioperative respiration monitoring via new noninvasive tools at the bedside for continuous measurements of RR, TV and MV.…”

“…Respiratory depression and hypoventilation due to residual anesthetics and opioid administration cause hypoxemia and hypercapnia in patients in the post-anesthesia care unit (PACU) and general hospital floor (GHF), which may lead to permanent disability or life-threating complications 1 – 5 . Respiration monitoring would benefit non-intubated patients not only in the PACU and GHF, but during procedural sedation where Propofol is increasingly used.…”

“…In spite of a recent article reporting a pulse oximetry’s accuracy issue associated with race or skin color 12 , it is commonly used to detect hypoxemia via measuring peripheral oxygen saturation (SpO 2 ). However, it often generates false or delayed alarms 5 , 13 . Partial pressure of end-tidal carbon dioxide (P et CO 2 ) has been used to detect hypercapnia.…”

Continuous Monitoring of Respiratory Rate with Wearable Sensor in Patients Admitted to Hospital with Pneumonia Compared with Intermittent Nurse-Led Monitoring in the United Kingdom: A Cost-Utility Analysis

“…Wearable sensors for monitoring of vital signs are still developing. Most of the current devices are in different stages of validation and undergoing feasibility study [ 8 , 10 ]. Based on a recent systematic review, clinical data are sparse, and cost data are lacking [ 8 ].…”

Unanticipated Respiratory Compromise on the Hospital Wards: It's a Major Problem!

“…Respiratory compromise is defined as a deterioration in respiratory function such that timely interventions are needed to prevent intubation or death. 1 In this month's issue, Bedoya et al 2 highlights a significant problem in hospitals today. Patients on general medical floors, often without continuous monitoring, are at risk for respiratory decompensation arising from progressing illness and opioid medications.…”