PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY,
PRODIGY, is a Medtronic-sponsored, prospective, observational, multisite study that derived and validated a Risk Prediction Tool. Its purpose is to identify adult patients receiving opioid medication in medical-surgical units who are at increased risk for opioid induced respiratory depression (OIRD), a form of respiratory compromise. Click here to learn more about the primary PRODIGY publication.
46% of patients receiving opioids in the medical-surgical units experience at least one or more episodes of respiratory depression.1
Medtronic offers two key technologies that may be used for continuous respiratory monitoring:
The secondary PRODIGY economics publication concludes that continuous respiratory monitoring has a high chance of being cost-effective3:
For each affected patient:
Potential cost savings for the institution ―
for monitoring patients in the high-risk or all-risk categories respectively:†3
A 20 percent reduction in patients with ≥ 1 RDE reports:4-6
PRODIGY Risk Category |
High |
High + Intermediate |
High + Intermediate + Low |
Median number of patients receiving opioids per hospital annually |
2,447 |
||
Patients in risk group |
34% |
36% |
30% |
Length of stay reduction |
103 days |
152 days |
204 days |
Avg annual hospital cost savings |
$535,531 |
$606,463 |
$688,221 |
Break-even point (percentage points in decreasing respiratory depression) |
1.5% |
2.5% |
3.5% |
†This assumes a 20 percent respiratory depression reduction and an annual general care floor volume of 2,447 patients receiving opioids per median-sized hospital. 90% of surgical patients and 45% of medical patients on U.S. general care floors receive opioids. Continuous pulse oximetry and capnography device pricing assumptions used list pricing for the following: a Capnostream™ portable respiratory monitor ($4300) prorated over 7 years; a Microstream™ capnography filterline ($14.50), and a disposable Nellcor™ pulse oximetry sensor ($8.50), resulting in $52.73 in device costs per continuously monitored patient stay on a medical surgical floor. For intermittent pulse oximetry monitoring, device pricing consisted of a multiparameter monitor ($3000) prorated over 7 years and a reusable pulse oximetry sensor ($65), resulting in $0.68 in device costs per patient stay. Additional information on pricing and assumptions are available in the study publication.
The primary objective of the PRODIGY trial was to develop a tool that helps clinicians assess patients at high risk for respiratory depression. This tool provides an easy-to-use PRODIGY Score, which helps guide clinicians in identifying patients who would benefit most from continuous monitoring including capnography and oximetry in medical-surgical units.
The PRODIGY risk stratification tool may support The Joint Commission’s recent language updates on monitoring postoperative patients receiving opioids as articulated in the Pain Assessment and Management Standards.7 The organization requires hospitals to implement an evidence-based mechanism to identify patients receiving opioids who are at high risk for adverse events.7
To learn more about PRODIGY and/or download the complimentary PRODIGY Risk Assessment Tool, visit www.Medtronic.com/PRODIGY.
Read the full PRODIGY economics publication in the Advances in Therapy Journal.
1. Khanna AK, Bergese S, Jungquist CR, et al. Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective, observational trial. Anesth Analg. Vol. 131(4). October 2020.
2. Saager L, Jiang W, Khanna A, et al. Respiratory depression on general care floors increases cost of care: results from the PRODIGY trial. American Society of Anesthesiologists Abstract Publication 2019.
3. Khanna A, Junquist C, Buhre W, Soto R, di Piazza F, Saager L. Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial. Adv Ther. 2021 May 24:1–15. doi: 10.1007/s12325-021-01779-7.
4. Stites M, Surprise J, McNiel J, Northrop D, De Ruyter M. Continuous Capnography Reduces the Incidence of Opioid-Induced Respiratory Rescue by Hospital Rapid Resuscitation Team. J Patient Saf. 2017.
5. Lam T, Nagappa M, Wong J, Singh M, Wong D, Chung F. Continuous Pulse Oximetry and Capnography Monitoring for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis. Anesth Analg. 2017;125(6):2019–2029.
6. Steele T, Eidem L, Bond J. Impact of Adoption of Smart Pump System With Continuous Capnography Monitoring on Opioid-Related Adverse Event Rates: Experience From a Tertiary Care Hospital. J Patient Saf. 2019.
7. The Joint Commission. What are the key concepts organizations need to understand regarding the pain management requirements in the Leadership (LD) and Provision of Care, Treatment, and Services (PC) chapters? January 4 2021. https://www.jointcommission.org/standards/standard-faqs/hospital-and-hospital-clinics/leadership-ld/000002161/.
The Microstream™ capnography and Nellcor™ monitoring systems should not be used as the sole basis for diagnosis or therapy and are intended only as an adjunct in patient assessment.