Cavalcante Alexandre N, Martin Yvette N, Sprung Juraj, Imsirovic Jasmin, Weingarten Toby N
Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Respiratory Motion, Inc., Waltham, MA, USA.
J Clin Monit Comput. 2018 Oct;32(5):929-935. doi: 10.1007/s10877-017-0093-0. Epub 2017 Dec 20.
An electrical impedance-based noninvasive respiratory volume monitor (RVM) accurately reports minute volume, tidal volume and respiratory rate. Here we used the RVM to quantify the occurrence of and evaluate the ability of clinical factors to predict respiratory depression in the post-anesthesia care unit (PACU). RVM generated respiratory data were collected from spontaneously breathing patients following intraperitoneal surgeries under general anesthesia admitted to the PACU. Respiratory depression was defined as low minute ventilation episode (LMVe, < 40% predicted minute ventilation for at least 2 min). We evaluated for associations between clinical variables including minute ventilation prior to opioid administration and LMVe following the first PACU administration of opioid. Also assessed was a low respiratory rate (< 8 breaths per minute) as a proxy for LMVe. Of 107 patients, 38 (36%) had LMVe. Affected patients had greater intraoperative opioid dose, P = 0.05. PACU opioids were administered to 45 (42.1%) subjects, of which 27 (25.2%) had LMVe (P = 0.42) within 30 min following opioid. Pre-opioid minute ventilation < 70% of predicted normal value was associated with LMVe, P < 0.01, (sensitivity = 100%, specificity = 81%).Low respiratory rate was a poor predictor of LMVe (sensitivity = 11.8%). Other clinical variables (e.g., obstructive sleep apnea) were not found to be predictors of LMVe. Using RVM we identified that mild, clinically nondetectable, respiratory depression prior to opioid administration in the PACU was associated with the development of substantial subsequent respiratory depression during the PACU stay.
一种基于电阻抗的无创呼吸容积监测仪（RVM）能够准确报告分钟通气量、潮气量和呼吸频率。在此，我们使用RVM来量化麻醉后护理单元（PACU）中呼吸抑制的发生率，并评估临床因素预测呼吸抑制的能力。从入住PACU的全身麻醉下接受腹腔手术的自主呼吸患者中收集RVM生成的呼吸数据。呼吸抑制被定义为低分钟通气发作（LMVe，预测分钟通气量<40%至少持续2分钟）。我们评估了包括阿片类药物给药前的分钟通气量等临床变量与PACU首次给予阿片类药物后的LMVe之间的关联。还评估了低呼吸频率（<每分钟8次呼吸）作为LMVe的替代指标。在107例患者中，38例（36%）出现LMVe。受影响的患者术中阿片类药物剂量更大，P = 0.05。45例（42.1%）受试者接受了PACU阿片类药物治疗，其中27例（25.2%）在阿片类药物给药后30分钟内出现LMVe（P = 0.42）。阿片类药物给药前的分钟通气量<预测正常值的70%与LMVe相关，P<0.01，（敏感性 = 100%，特异性 = 81%）。低呼吸频率对LMVe的预测能力较差（敏感性 = 11.8%）。未发现其他临床变量（如阻塞性睡眠呼吸暂停）是LMVe的预测因素。使用RVM我们发现，PACU中阿片类药物给药前轻度的、临床上无法检测到的呼吸抑制与PACU住院期间随后出现的严重呼吸抑制有关。
