Voscopoulos Christopher, Theos Kimberly, Tillmann Hein H A, George Edward
John A. Burns School of Medicine, University of Hawaii, 1356 Lusitana Street, Room 606A, Honolulu, HI, 96813, USA.
John A. Burns School of Medicine, University of Hawaii, 651 Ilalo St, Honolulu, HI, 96813, USA.
J Clin Monit Comput. 2017 Apr;31(2):417-426. doi: 10.1007/s10877-016-9841-9. Epub 2016 Feb 19.
Late detection of respiratory depression in non-intubated patients compromises patient safety. SpO is a lagging indicator of respiratory depression and EtCO has proven to be unreliable in non-intubated patients. A decline in minute ventilation (MV) is the earliest sign of respiratory depression. A non-invasive respiratory volume monitor (RVM) that provides accurate, continuous MV measurements enables clinicians to predict and quantify respiratory compromise. For this observational study, practitioners were blinded to the RVM measurements and pain management followed the usual routine. Patients were stratified by their MV on PACU admission and classified as "At-Risk" or "Not-At-Risk," with progression to "Low MV" status following opioids assessed for each category. The purpose was to determine if stratifying based on MV on PACU arrival could identify patients at higher risk for respiratory depression. Ability to identify in advance patients at higher risk for respiratory depression following standard opioid dosing would drive changes in pain management and improve patient care. RVM and opioid administration data from 150 PACU patients following elective joint-replacement surgery were collected in an observational study. "Predicted" MV (MV) and "Percent Predicted" (MV/MV × 100 %) were calculated for each patient using standard formulas. Prior to opioid administration, patients were classified as either "Not-At-Risk" (MV ≥ 80 % MV) or "At-Risk" (MV < 80 % MV). "Low MV" was defined as MV < 40 % MV. Post-operative apnea (POA) was defined as ≥5 ten-second apneas per hour of PACU stay. We compared the incidences of Low MV following a single opioid dose, POA, and Low MV at discharge for both groups. In the PACU, 74/150 patients received opioids. Within 15 min of opioid administration, 32 % (24/74) developed Low MV. The risk-stratification algorithm identified 22/24 patients (92 % sensitivity). Only 46 % of them had POA, and the majority had Low MV without POA. At discharge, 29/150 patients had Low MV and those receiving opioids were 50 % more likely to display Low MV (23 vs. 16 %). The RVM can identify patients at-risk for opioid-induced respiratory depression and/or experiencing POA. Monitoring of MV can guide opioid-dosing regimens and may increase patient safety across the continuum of care.
非插管患者呼吸抑制的延迟检测会危及患者安全。脉搏血氧饱和度（SpO）是呼吸抑制的滞后指标，而呼气末二氧化碳分压（EtCO）已被证明在非插管患者中不可靠。分钟通气量（MV）下降是呼吸抑制的最早迹象。一种能够提供准确、连续MV测量值的无创呼吸容量监测仪（RVM）使临床医生能够预测和量化呼吸功能损害。在这项观察性研究中，从业者对RVM测量值不知情，疼痛管理遵循常规流程。患者根据其在麻醉后护理单元（PACU）入院时的MV进行分层，分为“有风险”或“无风险”，并评估每类患者在使用阿片类药物后进展为“低MV”状态的情况。目的是确定根据PACU到达时的MV进行分层是否能识别出呼吸抑制风险较高的患者。能够提前识别出在标准阿片类药物给药后呼吸抑制风险较高的患者将推动疼痛管理的改变并改善患者护理。在一项观察性研究中，收集了150例择期关节置换手术后PACU患者的RVM和阿片类药物给药数据。使用标准公式为每位患者计算“预测”MV（MV）和“预测百分比”（MV/MV×100%）。在给予阿片类药物之前，患者被分类为“无风险”（MV≥80%MV）或“有风险”（MV<80%MV）。“低MV”定义为MV<40%MV。术后呼吸暂停（POA）定义为PACU停留期间每小时≥5次持续10秒的呼吸暂停。我们比较了两组患者单次给予阿片类药物后低MV、POA以及出院时低MV的发生率。在PACU中，74/150例患者接受了阿片类药物。在给予阿片类药物后15分钟内，32%（24/74）的患者出现低MV。风险分层算法识别出22/24例患者（敏感性为92%）。其中只有46%的患者发生POA，大多数患者出现低MV但无POA。出院时，150例患者中有29例出现低MV，接受阿片类药物的患者出现低MV的可能性高出50%（23例 vs. 16例）。RVM能够识别出有阿片类药物引起的呼吸抑制和/或发生POA风险的患者。监测MV可以指导阿片类药物给药方案，并可能在整个护理过程中提高患者安全性。
