Kozub Elizabeth, Uttermark Anne, Skoog Richard, Dickey William
J Healthc Qual. 2022;44(1):e7-e14. doi: 10.1097/JHQ.0000000000000322.
Opioid-induced respiratory depression (OIRD) is a serious complication that can lead to negative outcomes. There are known risk factors for OIRD; however, a lack of national guidelines for the prevention and early detection of OIRD exists.
An evidence-based practice study was conducted to create an enhanced monitoring (EM) program. The EM program consisted of risk stratification of surgical spine patients, including the use of STOP-BANG screening for obstructive sleep apnea, capnography monitoring, use of home positive airway pressure therapy, capnography alarm optimization, hospitalist consultation, nursing education, and patient education.
Approximately 17% (N = 937/5,462) of surgical spine patients were enrolled in the EM program. Fifty-six percent of EM patients were monitored with capnography and had out of range end-tidal carbon dioxide levels 17% of the time. The rate of transfers to the intensive care unit (ICU) for OIRD decreased, though not statistically significant (p = .151).
The EM program with risk stratification was found to reduce transfers to the ICU for OIRD. Although not statistically significant, the decreased number of transfers was clinically significant. Engagement of the interprofessional team and capnography alarm parameter optimization helped to reduce nonactionable alarms.
阿片类药物引起的呼吸抑制（OIRD）是一种可导致不良后果的严重并发症。OIRD存在已知的危险因素；然而，目前缺乏关于OIRD预防和早期检测的国家指南。
开展了一项基于证据的实践研究，以创建一个强化监测（EM）项目。该EM项目包括对脊柱手术患者进行风险分层，包括使用STOP-BANG筛查阻塞性睡眠呼吸暂停、二氧化碳描记监测、使用家庭气道正压治疗、优化二氧化碳描记报警、住院医师会诊、护理教育和患者教育。
约17%（N = 937/5462）的脊柱手术患者纳入了EM项目。56%的EM患者接受了二氧化碳描记监测，其中17%的时间呼气末二氧化碳水平超出范围。因OIRD转入重症监护病房（ICU）的比率有所下降，尽管无统计学意义（p = 0.151）。
发现采用风险分层的EM项目可减少因OIRD转入ICU的情况。尽管无统计学意义，但转入人数的减少具有临床意义。跨专业团队的参与和二氧化碳描记报警参数的优化有助于减少不可采取行动的警报。
