From the Departments of Nursing.
Quality & Safety.
J Patient Saf. 2021 Sep 1;17(6):e557-e561. doi: 10.1097/PTS.0000000000000408.
The aim of this study was to determine the impact of end tidal carbon dioxide or capnography monitoring in patients requiring patient-controlled analgesia (PCA) on the incidence of opioid-induced respiratory depression (OIRD) in the setting of rapid response.
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.
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 (χ2 = 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).
Continuous capnography monitoring in patients receiving PCA significantly reduces the incidence of OIRD in the setting of rapid response and unplanned transfers to a higher level of care.
本研究旨在确定在需要患者自控镇痛（PCA）的患者中，使用呼气末二氧化碳或二氧化碳描记监测对快速反应中阿片类药物引起的呼吸抑制（OIRD）发生率的影响。
对 2012 年 1 月至 2015 年 12 月期间，以纳洛酮阳性反应定义的快速反应中 OIRD 的发生率进行回顾性分析。2013 年 3 月，对所有使用 PCA 的患者实施连续二氧化碳描记监测。
在快速反应中，使用 OIRD 的患者发生率为 0.4%。在实施二氧化碳描记监测后，快速反应中 OIRD 的发生率降低至 0.2%，具有统计学意义（χ2=46.246；df，1；P<0.0001）。与这些事件相关的转至更高级别护理的比率也降低了 79%（基线，7.6 次/月；干预后，1.6 次/月）。
在接受 PCA 的患者中进行连续二氧化碳描记监测可显著降低快速反应中 OIRD 的发生率和计划外转至更高级别护理的比率。
