Anesthesia and Pain Research Unit, Department of Anesthesiology, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
Department of Anesthesiology, Antoni van Leeuwenhoek Hospital, 1066 CX, Amsterdam, The Netherlands.
J Clin Monit Comput. 2021 Oct;35(5):1093-1102. doi: 10.1007/s10877-020-00564-1. Epub 2020 Jul 29.
Although postoperative adverse respiratory events, defined by a decrease in respiratory rate (RR) and/or a drop in oxygen saturation (SpO), occur frequently, many of such events are missed. The purpose of the current study was to assess whether continuous monitoring of the integrated pulmonary index (IPI), a composite index of SpO, RR, end-tidal PCO and heart rate, alters our ability to identify and prevent adverse respiratory events in postoperative patients. Eighty postoperative patients were subjected to continuous respiratory monitoring during the first postoperative night using RR and pulse oximetry and the IPI monitor. Patients were randomized to receive intervention based on standard care (observational) or based on the IPI monitor (interventional). Nurses were asked to respond to adverse respiratory events with an intervention to improve the patient's respiratory condition. There was no difference in the number of patients that experienced at least one adverse respiratory event: 21 and 16 in observational and interventional group, respectively (p = 0.218). Compared to the observational group, the use of the IPI monitor led to an increase in the number of interventions performed by nurses to improve the respiratory status of the patient (average 13 versus 39 interventions, p < 0.001). This difference was associated with a significant reduction of the median number of events per patient (2.5 versus 6, p < 0.05) and a shorter median duration of events (62 s versus 75 s, p < 0.001). The use of the IPI monitor in postoperative patients did not result in a reduction of the number of patients experiencing adverse respiratory events, compared to standard clinical care. However, it did lead to an increased number of nurse interventions and a decreased number and duration of respiratory events in patients that experienced postoperative adverse respiratory events.
尽管术后出现呼吸频率（RR）下降和/或血氧饱和度（SpO）下降等不良呼吸事件较为常见，但很多此类事件都被漏诊。本研究旨在评估连续监测综合肺指数（IPI）——SpO、RR、呼气末 PCO 和心率的综合指数——是否能提高我们识别和预防术后患者不良呼吸事件的能力。
术后 80 例患者在术后第一晚接受 RR 和脉搏血氧饱和度以及 IPI 监测仪的连续呼吸监测。患者随机分为标准护理（观察组）或基于 IPI 监测仪的干预（干预组）。护士需要根据不良呼吸事件的情况，通过干预来改善患者的呼吸状况。
观察组和干预组分别有 21 例和 16 例患者至少经历了一次不良呼吸事件，两组间无差异（p = 0.218）。与观察组相比，使用 IPI 监测仪会增加护士为改善患者呼吸状况而进行的干预次数（平均干预次数分别为 13 次和 39 次，p < 0.001）。这种差异与每个患者的不良事件中位数显著减少（2.5 次与 6 次，p < 0.05）和事件中位数持续时间缩短（62 秒与 75 秒，p < 0.001）相关。
与标准临床护理相比，在术后患者中使用 IPI 监测仪并未减少出现不良呼吸事件的患者数量。但是，它确实导致接受术后不良呼吸事件的患者的护士干预次数增加，且呼吸事件的数量和持续时间减少。
