Respiratory depression in low acuity hospital settings-Seeking answers from the PRODIGY trial

被引:35
作者
Khanna, Ashish K. [1 ,2 ,3 ]
Overdyk, Frank J. [4 ]
Greening, Christine [5 ]
Di Stefano, Paola [6 ]
Buhre, Wolfgang F. [7 ]
机构
[1] Cleveland Clin, Ctr Crit Care, Cleveland, OH 44106 USA
[2] Cleveland Clin, Dept Gen Anesthesiol, Cleveland, OH 44106 USA
[3] Cleveland Clin, Dept Outcomes Res, Cleveland, OH 44106 USA
[4] Roper St Francis Hlth Syst, Charleston, SC USA
[5] Medtron Minimally Invas Therapies Grp, Boulder, CO USA
[6] Medtron Reg Clin Ctr, Rome, Italy
[7] Univ Med Ctr Maastricht, Dept Anesthesiol & Pain Therapy, Maastricht, Netherlands
关键词
Respiratory depression; Ward; Cardiorespiratory monitoring; Continuous; Capnography; Prediction; INTENSIVE-CARE-UNIT; RAPID-RESPONSE SYSTEMS; MEAN ARTERIAL-PRESSURE; NONCARDIAC SURGERY; POSTOPERATIVE HYPOXEMIA; EMERGENCY-DEPARTMENT; CAPACITY STRAIN; PAIN MANAGEMENT; COHORT ANALYSIS; OUTCOMES;
D O I
10.1016/j.jcrc.2018.06.014
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Predicting episodes or severity of cardiorespiratory decompensation has proved to be challenging in patients with stable surgical or medical conditions, recovering on the general care floor (ward). Critical cardiorespiratory events on hospital floors may be prevented by early detection of deterioration using continuous, electronic cardiorespiratory monitoring (CEM). The PRediction of Opioid-induced Respiratory Depression In Patients Monitored by capnoGraphY (PRODIGY) trial investigates CEM using pulse oximetry and capnography in 1650 patients at 16 centers in North America, Europe, and Asia (ClinicalTrials.gov Identifier: NCT02811302). The primary goal of the study is to derive a risk prediction score for respiratory depression (RD) on the ward. The validation-derivation cohort design will derive this score from RD detected by continuous, blinded, multiparameter cardiorespiratory (heart rate, respiratory rate, end tidal carbon dioxide, and pulse oximetry) monitoring of patients on the ward receiving parenteral (including epidural) opioids for primary analgesia. This review provides a comprehensive synopsis on respiratory compromise in lower acuity hospital settings (ward) and describes the protocol of the PRODIGY trial as a means to enable prediction and early response to these events. (C) 2018 Elsevier Inc. All rights reserved.
引用
收藏
页码:80 / 87
页数:8
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