Department of Anesthesiology, University Hospital, 1 H427, University of Michigan, Box 0048, 1500 E Medical Center Drive, Ann Arbor, MI 48109-004, USA.
Respir Care. 2010 Apr;55(4):414-8.
Obstructive sleep apnea (OSA) increases the risk of central and obstructive apneas after anesthesia, but the vast majority of patients with OSA are undiagnosed preoperatively. Current guidelines promote the use of postoperative continuous positive airway pressure (CPAP) in patients with OSA. Owing to the complex postoperative requirements of these patients, respiratory therapists (RTs) could substantially improve these patients' clinical management in the immediate postoperative period. We describe a system that identifies patients with suspected or documented OSA and automatically alerts the perioperative RT.
Patients who presented for surgery were preoperatively assessed, and if the patient had a diagnosis of OSA or OSA risk factors, the perioperative RT automatically received a paging alert, after the surgery. The RT reviewed the patient postoperatively and instituted CPAP or bi-level positive airway pressure (BiPAP), as indicated. We collected data on triggers for the automated alerts and utilization of CPAP and BiPAP. We reviewed risk-management data to analyze the effect of this intervention on postsurgical sudden-onset acute respiratory compromise.
Of 7,422 patients who presented for surgery over a 5-month period, 766 had an OSA diagnosis or OSA risk factors. There were an average of 7-8 alerts per work day (range 2-18 alerts per day). On average, 2 patients per day were treated with CPAP/BiPAP in the post-anesthesia care unit or the postoperative general ward as a result of the alerts. The median paging alert time was 10:30 am. There were no episodes of sudden-onset postoperative acute respiratory compromise after institution of the OSA alert system.
As part of a hospital-wide postoperative policy, our automated OSA alert and perioperative RT system helped prevent sudden-onset acute respiratory compromise in postoperative patients with OSA or at risk of OSA.
阻塞性睡眠呼吸暂停（OSA）会增加麻醉后中枢性和阻塞性呼吸暂停的风险，但绝大多数 OSA 患者在术前未被诊断。目前的指南提倡对 OSA 患者术后使用持续气道正压通气（CPAP）。由于这些患者术后的需求复杂，呼吸治疗师（RT）可以在术后即刻极大地改善这些患者的临床管理。我们描述了一种系统，该系统可以识别疑似或有记录的 OSA 患者，并自动向围手术期 RT 发出警报。
接受手术的患者在术前进行评估，如果患者有 OSA 或 OSA 危险因素的诊断，则 RT 在手术后会自动收到寻呼警报。RT 在术后对患者进行检查，并根据需要使用 CPAP 或双水平气道正压通气（BiPAP）。我们收集了自动警报触发因素以及 CPAP 和 BiPAP 使用的数据。我们审查了风险管理数据，以分析该干预措施对术后突发急性呼吸窘迫的影响。
在 5 个月的时间里，有 7422 名患者接受了手术，其中 766 名患者有 OSA 诊断或 OSA 危险因素。平均每个工作日有 7-8 次警报（每天 2-18 次警报）。由于警报，平均每天有 2 名患者在麻醉后护理单元或术后普通病房接受 CPAP/BiPAP 治疗。寻呼警报时间的中位数为上午 10 点 30 分。在实施 OSA 警报系统后，没有发生术后突发急性呼吸窘迫的情况。
作为医院范围内术后政策的一部分，我们的自动 OSA 警报和围手术期 RT 系统有助于预防 OSA 或有 OSA 风险的术后患者突发急性呼吸窘迫。
