Driver C Noelle, Laporta Mariana L, Bergese Sergio D, Urman Richard D, Di Piazza Fabio, Overdyk Frank J, Sprung Juraj, Weingarten Toby N
From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota.
Department of Anesthesiology and Neurological Surgery, Stony Brook University School of Medicine, Stony Brook, New York.
Anesth Analg. 2021 May 1;132(5):1206-1214. doi: 10.1213/ANE.0000000000005478.
The frequency and temporal distribution of postoperative respiratory depression (RD) events are not completely understood. This study determined the temporal distribution and frequency of RD episodes in postsurgical patients continuously monitored by bedside capnography and pulse oximetry.
This was a post hoc study of a subset of postsurgical patients enrolled in The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial from 2 sites in the United States. These patients had undergone continuous bedside monitoring on general care wards. These data were adjudicated for potential RD episodes. The number of RD episodes per patient and the time of each RD episode were determined. The first RD episode experienced by a patient was classified as an "initial" episode, and the initial and all subsequent RD episodes experienced by a patient were classified as "all" episodes. A PRODIGY risk score was calculated.
Data analyzed from 250 patients contained 2539 RD episodes in 155 (62.0%, 95% confidence interval, 55.7-68.0) patients with median 2 [0-8], range of 0-545 RD episodes per patient, with a PRODIGY risk score distribution of 100 (40.0%) low, 79 (31.6%) intermediate, 70 (28.0%) high (missing data from 1 patient). Median time to the initial RD episode was 8.8 [5.1-18.0] hours postoperatively. There was a peak occurrence of initial RD events between 14:00 and 20:00 on the day of surgery, and these were associated with a large number of subsequent events in the same timeframe. The peak time of all RD episodes occurred from 02:00 to 06:00. Patients with high PRODIGY risk scores had higher incidence and greater number of RD episodes per patient (P < .001, overall comparisons between groups for both incidence [χ2] and number of episodes [Kruskal-Wallis test]).
Continuous monitoring of surgical patients demonstrates that RD episodes are common, and risk increases with higher PRODIGY scores. In this patient cohort, the rate of initial RD episodes peaked in the afternoon to early evening, while peak rate of all RD episodes occurred in early morning. Further, among patients with RD episodes, the number of episodes increased with higher PRODIGY scores.
术后呼吸抑制（RD）事件的发生频率和时间分布尚未完全明确。本研究通过床边二氧化碳描记法和脉搏血氧饱和度测定法对手术患者进行持续监测，以确定RD发作的时间分布和频率。
这是一项对参与美国两个地点的二氧化碳描记法监测阿片类药物诱发呼吸抑制预测（PRODIGY）试验的部分手术患者进行的事后分析研究。这些患者在普通护理病房接受了持续的床边监测。对这些数据进行判定以确定潜在的RD发作情况。确定每位患者的RD发作次数以及每次RD发作的时间。将患者经历的首次RD发作归类为“初始”发作，将患者经历的初始发作及所有后续发作归类为“所有”发作。计算PRODIGY风险评分。
对250例患者的数据分析显示，155例（62.0%，95%置信区间，55.7 - 68.0）患者发生了2539次RD发作，每位患者的RD发作次数中位数为2次[0 - 8次]，范围为0 - 545次，PRODIGY风险评分分布为低风险100例（40.0%）、中风险7 9 例（31.6%）、高风险70例（28.0%）（1例患者数据缺失）。首次RD发作的中位时间为术后8.8小时[5.1 - 18.0小时]。手术当天14:00至20:00之间首次RD事件的发生率最高，且这些事件与同一时间段内大量的后续事件相关。所有RD发作的高峰时间为02:00至06:00。PRODIGY风险评分高的患者发病率更高，每位患者的RD发作次数更多（P < .001，组间发病率[χ2]和发作次数[Kruskal - Wallis检验]的总体比较）。
对手术患者的持续监测表明，RD发作很常见，且风险随PRODIGY评分升高而增加。在该患者队列中，首次RD发作的发生率在下午至傍晚达到峰值，而所有RD发作的峰值发生率出现在清晨。此外，在发生RD发作的患者中，发作次数随PRODIGY评分升高而增加。
原文中“79 (31.6%) intermediate”这里“7 9”疑似有误，我按“79”进行了翻译。
