Respiratory Compromise

Respiratory compromise is a state in which there is a high likelihood of decompensation into respiratory insufficiency and failure, as well as respiratory arrest or death, but in which specific interventions (continuous monitoring and therapies) might prevent or mitigate decompensation.¹

Discover below which respiratory and monitoring solutions from Medtronic can help with the early identification of respiratory compromise.

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Respiratory failure occurs when one of the gas-exchange functions—oxygenation or CO2 elimination—fails.² In clinical studies evaluating the incidence or impact of respiratory insufficiency, the condition may be defined in a variety of ways, such as: a decrease in respiratory rate, a reduction in oxygen saturation of hemoglobin, or as a change in arterial blood gasses.^3,4,5,6,7 Definitions and corresponding terms used to represent respiratory insufficiency in literature vary significantly.

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Multiple underlying conditions may be responsible for evolving respiratory compromise.⁸The likelihood for developing respiratory compromise may be influenced by a number of patient-specific or treatment-specific factors.⁹

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Changes in respiratory vital signs corresponding with respiratory compromise often precede in-hospital deterioration and are associated with increased mortality.^10-12

Many in-hospital declines may be preventable with better monitoring and early intervention to address evolving respiratory compromise.^13,14

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Respiratory compromise imposes substantial burdens on patient health and hospital costs.^15,16

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Evidence has demonstrated that the implementation of automated early warning score systems may improve patient outcome, and reduce the cost of implementation compared to traditional manually calculated systems.^17,18

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Changes in patient populations, along with economic and practical considerations, have led to an overall increase in patient acuity on the general care floor (GCF). Despite the presence of higher risk patients, current GCF surveillance is often limited to isolated spot checks of core vital signs, such as heart rate, respiratory rate, blood pressure and temperature, with such observations often limited to every 4 hours, which leaves patients unmonitored 96% of the time.¹⁹ Therefore, these patients may be at increased risk for respiratory compromise.

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Incidence of respiratory adverse events in moderate to deep procedural sedation is often underestimated, still reported in published clinical studies²⁰ and its consequences may, even if rarely, lead to death²⁰.

The outcomes pledge program by Medtronic will help you measure the incidence of adverse events in your own setting, with your own clinical team and your own protocols and assess the impact of capnography monitoring on the prevention of such events.

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1. Respiratory Compromise Institute. http://www.respiratorycompromise.org/. 2017.
2. https://www.americannursetoday.com/caring-patients-respiratory-failure/ , accessed Sept 6th, 2019.
3. Cacho, G., Perez-Calle, J. L., Barbado, A., Lledo, J. L., Ojea, R., & Fernandez-Rodriguez, C. M. Capnography is superior to pulse oximetry for the detection ofrespiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102(2):86-89.
4. Hanna, M. H., Elliott, K. M., & Fung, M. Randomized, double-blind study of theanalgesic efficacy of morphine-6-glucuronide versus morphine sulfate for postoperativepain in major surgery. Anesthesiology. 2005;102(4):815-821.
5. Overdyk, F. J., Carter, R., Maddox, R. R., Callura, J., Herrin, A. E., & Henriquez, C.Continuous oximetry/capnometry monitoring reveals frequent desaturation andbradypnea during patient-controlled analgesia. Anesth Analg. 2007;105(2):412-418.
6. Sun, Z., Sessler, D. I., Dalton, J. E., et al. Postoperative Hypoxemia Is Common andPersistent: A Prospective Blinded Observational Study. Anesth Analg. 2015;121(3):709-715.
7. Weingarten, T. N., Herasevich, V., McGlinch, M. C., et al. Predictors of DelayedPostoperative Respiratory Depression Assessed from Naloxone Administration. AnesthAnalg. 2015;121(2):422-429.
8. Lynn, L. A., & Curry, J. P. Patterns of unexpected in-hospital deaths: a root causeanalysis. Patient Saf Surg. 2011;5(1):3.
9. Alvarez, M. P., Samayoa-Mendez, A. X., Naglak, M. C., Yuschak, J. V., & Murayama,K.M. Risk Factors for Postoperative Unplanned Intubation: Analysis of a NationalDatabase. Am Surg. 2015;81(8):820-825.
10. Barfod, C., Lauritzen, M. M., Danker, J. K., et al. Abnormal vital signs are strongpredictors for intensive care unit admission and in-hospital mortality in adults triaged inthe emergency department - a prospective cohort study. Scand J Trauma Resusc EmergMed. 2012;20:28.
11. Buist, M., Bernard, S., Nguyen, T. V., Moore, G., & Anderson, J. Associationbetween clinically abnormal observations and subsequent in-hospital mortality: aprospective study. Resuscitation. 2004;62(2):137-141.
12. Chaboyer, W., Thalib, L., Foster, M., Ball, C., & Richards, B. Predictors of adverseevents in patients after discharge from the intensive care unit. Am J Crit Care.2008;17(3):255-263; quiz 264.
13. Sun, Z., Sessler, D. I., Dalton, J. E., et al. Postoperative Hypoxemia Is Common andPersistent: A Prospective Blinded Observational Study. Anesth AnalgAnesthesiology.2010;112(2):282-287.
14. Taenzer, A. H., Pyke, J. B., McGrath, S. P., & Blike, G. T. Impact of pulse oximetrysurveillance on rescue events and intensive care unit transfers: a before-and-afterconcurrence study. Anesthesiology. 2010;112(2):282-287.
15. Andersen, L. W., Berg, K. M., Chase, M., et al. Acute respiratory compromise oninpatient wards in the United States: Incidence, outcomes, and factors associated with in-hospital mortality. Resuscitation. 2016;105:123-129.
16. Wang, H. E., Abella, B. S., & Callaway, C. W. Risk of cardiopulmonary arrest afteracute respiratory compromise in hospitalized patients. Resuscitation. 2008;79(2):234- 240.
17. Bellomo, R., Ackerman, M., Bailey, M., et al. A controlled trial of electronicautomated advisory vital signs monitoring in general hospital wards. Crit Care Med.2012;40(8):2349-2361.
18. Slight, S. P., Franz, C., Olugbile, M., Brown, H. V., Bates, D. W., & Zimlichman, E.The return on investment of implementing a continuous monitoring system in generalmedical-surgical units.Crit Care Med. 2014;42(8):1862-1868.
19. Weinger, M. B., & Lee, L. A. No Patient Shall Be Harmed By Opioid-InducedRespiratory Depression.APSF Newsletter. 2011;26(2):21.
20. Leslie K, Allen ML, Hessian EC, Peyton PJ, Kasza J, Courtney A, et al. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: A prospective cohort study. Br J Anaesth. 2017;118(1):90–9. https://pubmed.ncbi.nlm.nih.gov/28039246/
21. Cacho, G., Perez-Calle, J. L., Barbado, A., Lledo, J. L., Ojea, R., & Fernandez-Rodriguez, C. M. Capnography is superior to pulse oximetry for the detection ofrespiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102(2):86-89.
22. Maddox, R. R., Oglesby, H., Williams, C. K., Fields, M., & Danello, S. (2008).Continuous Respiratory Monitoring and a "Smart" Infusion System Improve Safety ofPatient-Controlled Analgesia in the Postoperative Period.
23. Overdyk, F. J., Carter, R., Maddox, R. R., Callura, J., Herrin, A. E., & Henriquez, C.Continuous oximetry/capnometry monitoring reveals frequent desaturation andbradypnea during patient-controlled analgesia. Anesth Analg. 2007;105(2):412-418.

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