SESSION TITLE: Critical Care Posters I
SESSION TYPE: Poster Presentations
PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM
PURPOSE: Opioid-induced respiratory depression (OIRD) and post-operative apnea (POA), can lead to increased post-operative complications. Identification of OIRD and POA remains difficult with current monitoring technology. A novel, non-invasive, Respiratory Volume Monitor (RVM) that provides continuous, real-time, measurements of minute ventilation (MV), tidal volume (TV) and respiratory rate (RR), is now available. The RVM was utilized to detect the effect of opioids on respiratory status and apneic breathing patterns.
METHODS: Digital respiratory traces were collected from 132 patients. The predicted MV (MVPRED) for each patient was calculated based on BSA. The MV measured, prior to opioid administration, by the RVM (MVMEASURED) was used to calculate the “Percent Predicted” MV (MVMEAS /MVPRED x100%). Patients were then stratified into two categories: “At-Risk”, MV <80% MVPRED and “Not-at-Risk”, MV >80% MVPRED. After opioid dosing, patients with MV less than 40% MVPRED were categorized as “Un-Safe”. POA was defined as >5 apneic or hypopneic events (no detected breaths; or a TV reduction > 50% lasting >10 seconds) per hour.
RESULTS: 50/132 patients received opioids. Baseline MV was 7.2±0.5 L/min, (93.1%±6.1% MVPRED). A MV-based protocol classified 18 of the 50 patients as “At-Risk” prior to opioid. After the first opioid dose “At-Risk” patients experienced an average MV decrease to 36.7%±8.5% of MVPRED whereas 32 “Not-at-Risk” patients experienced an average MV decrease to 76.9%±6.3% of MVPRED. In 13 of the 18 patients classified as “At-Risk”, MV decreased into the “Un-Safe” range after opioid. Only 1/32 patients identified as “Not-at-Risk” had a decrease in MV to “Un-Safe”. The protocol had a sensitivity of 93%, specificity of 86% and negative predictive value of 97%. 26 of the 132 patients displayed POA. 14 of the 26 patients with POA also received opioids; 6 of these 14 demonstrated an “Un-Safe” MV after opioid administration. Twelve patients experienced POA without receiving opioids.
CONCLUSIONS: This study demonstrates that “At-Risk” and “Un-Safe” respiratory patterns occur frequently in the PACU and have the potential to continue once patients are transferred to the floor. RVM provides continuous non-invasive measurements that quantify respiration in patients and objectively report OIRD and POA.
CLINICAL IMPLICATIONS: The use of RVM can aid in decision-making regarding opioid use recognition and management of apnea, with the potential for decreasing complications and cost and improving patient safety.
DISCLOSURE: Diane Ladd: Employee: Repiratory Motion, Inc Jenny Freeman: Employee: Respiratory Motion, Inc., Shareholder: Respiratory Motion, Inc. The following authors have nothing to disclose: Edward George
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