Stites M, Surprise J, McNiel J, Northrop D, De Ruyter M. J Patient Saf. 2017 Jul 20. doi: 10.1097/PTS.0000000000000408
This is retrospective sentinal study. The authors determined the impact of end tidal carbon dioxide or capnography monitoring in patients requiring patient-controlled analgesia (PCA) on the incidence of opioid-induced respiratory depression (OIRD) in the setting of rapid response. A retrospective analysis was conducted in an urban tertiary care facility on the incidence of OIRD in the setting of rapid response as defined by a positive response to naloxone from January 2012 to December 2015. In March 2013, continuous capnography monitoring was implemented for all patients using PCA.
The preintervention incidence of OIRD in the setting of rapid response was 0.04% of patients receiving opioids. After the implementation of capnography, the incidence of OIRD in the setting of rapid response was reduced to 0.02%, which was statistically significant (P < 0.0001). The rate of transfers to a higher level of care associated with these events was also reduced by 79% (baseline, 7.6 transfers/month; postintervention, 1.6 transfers/month). The conclusion of the authors is continuous capnography monitoring in patients receiving PCA significantly reduces the incidence of OIRD in the setting of rapid response and unplanned transfers to a higher level of care.
Comments by Bhavani Shankar Kodali MD
The most critical issue currently is how to monitor postoperative patients receiving opioids. There is not full proof method yet established for this purpose. Capnography, despite its limitations, offers one mode of monitoring. Some medical centers are routinely monitoring respiratory status in postoperative patients with capnography. Capnography serves well for this purpose provided the care providers are trained in the proper use and interpretation of capnography.