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Chapter 15 - Respiratory Monitoring in Low-Intensity Settings

Published online by Cambridge University Press:  28 April 2020

By
Andrew B. Leibowitz  and
Adel Bassily-Marcus
Edited by
Andrew B. Leibowitz  and
Suzan Uysal
Andrew B. Leibowitz
Affiliation:
Icahn School of Medicine at Mount Sinai
Suzan Uysal
Affiliation:
Icahn School of Medicine at Mount Sinai
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Summary

Respiratory monitoring utilizing pulse oximetry and expired carbon dioxide (CO2) measurement has been an operating room standard since the 1980s. Post-anesthesia and intensive care units adopted pulse oximetry shortly thereafter and only recently have embraced expired CO2 monitoring. However, there remains a need for monitoring the respiratory function of patients in low-intensity hospital environments (i.e., other than operating rooms, post-anesthesia care units, or intensive care units), since they frequently experience respiratory compromise that may progress, require tracheal intubation, and may deteriorate to cardiopulmonary arrest. This is especially true in patients with obesity, obstructive sleep apnea, and opioid administration, which are common risk factors. Monitoring for respiratory compromise in low-intensity environments, however, is challenging. This chapter addresses the use of pulse oximetry, expired CO2, photoplethysmography, bioimpedance, and acoustic monitoring in these settings.

Keywords

Monitoringrespiratorypulse oximetrycarbon dioxidephotoplethysmographybioimpedanceacoustic
Type
Chapter
Information
Modern Monitoring in Anesthesiology and Perioperative Care , pp. 148 - 153
Publisher: Cambridge University Press
Print publication year: 2020

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References

Lynn, LL, Curry, JP. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Safety in Surgery 2011; 5(3):1–24.CrossRefGoogle ScholarPubMed
Hai, F, Porhomayon, J, Vermont, L, et al. Postoperative complications in patients with obstructive sleep apnea: a meta-analysis. J Clin Anesth 2014; 26(8):591–600.Google Scholar
Fernandez-Bustamante, A, Bartels, K, Clavijo C, et al. Preoperatively screened obstructive sleep apnea is associated with worse postoperative outcomes than previously diagnosed obstructive sleep apnea. Anesth Analg 2017;125(2):593–602.Google Scholar
Lee, LA, Caplan, RA, Stephens, LS, et al. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology 2015;122(3):659–65.Google Scholar
Khanna, AK, Overdyk, FJ, Greening, C, Di Stefano, P, Buhre, WF. Respiratory depression in low acuity hospital settings – seeking answers from the PRODIGY trial. J Crit Care 2018;47:80–7.Google Scholar
Lam, T, Nagappa, M, Wong, J, et al. Continuous pulse oximetry and capnography monitoring for postoperative respiratory depression and adverse events: a systemic review and meta-analysis. Anesth Analg 2017;125:2019–29.Google Scholar
Pedersen, T, Nicholson, A, Hovhannisyan, K, et al. Pulse oximetry for perioperative monitoring. Cochrane Database of Systematic Reviews 2014, Issue 3. Art. No.: CD002013.Google Scholar
Duncan, PG, Cohen, MM. Pulse oximetry and capnography in anaesthetic practice: an epidemiological appraisal. Can J Anaesth 1991;38(5):619–25.CrossRefGoogle ScholarPubMed
Blankush, JM, Freeman, R, McIlvaine, J, et al. Implementation of a novel postoperative monitoring system using automated Modified Early Warning Scores (MEWS) incorporating end-tidal capnography. J Clin Monit Comput 2017;31(5):1081–92.CrossRefGoogle ScholarPubMed
Weiniger, C, Akdagli, S, Turvall, E, et al. Prospective observational investigation of capnography and pulse oximetry monitoring after cesarean delivery with intrathecal morphine. Anesth Analg 2019;128(3):513–22.CrossRefGoogle ScholarPubMed
Chhajed, PN, Gehrer, S, Pandey, KV. Utility of transcutaneous capnography for optimization of non-invasive ventilation pressure. J Clin Diagn Res 2016;10(9):OC06–OC09.Google Scholar
Charlton, PH, Bonnici, T, Tarassenko, L, et al. As assessment of algorithms to estimate respiratory from the electrocardiogram and photoplethysmogram. Physiol Meas 2016;37(4):610–26.Google Scholar
Bergese, SD, Mestek, ML, Kelley, SD, et al. Multicenter study validating accuracy of a continuous respiratory rate measurement derived from pulse oximetry: a comparison with capnography. Anesth Analg 2017; 124(4):1153–9.Google Scholar
Voscopoulos, C, MacNabb, CM, Freeman, J, et al. Continuous noninvasive respiratory volume monitoring for the identification of patients at risk for opioid-induced respiration and obstructive breathing patterns. J Trauma Acute Care Surg. 2014;77:(s208–215).CrossRefGoogle ScholarPubMed
Williams, GW II, George, CA, Harvey, BC, Free, JE. A comparison of measurements of changes in respiratory status in spontaneously breathing volunteers by the expiron noninvasive respiratory volume monitor versus the capnostream capnometer. Anesth Analg 2017;124:120–6.CrossRefGoogle ScholarPubMed
Menner, A, Hu, P, Stansbury, L, et al. Acoustic sensor versus electrocardiographically derived respiratory rate in unstable trauma patients. J Clin Monit Comput 2017;31:765–72.Google Scholar
Patino, M, Kalin, M, Griffin, A, et al. Comparison of postoperative respiratory monitoring by acoustic and transthoracic impedance technologies in pediatric patients at risk or respiratory depression. Anesth Analg 2017;124(6)1937–42.Google Scholar
McGrath, SP, Pyke, J, Taenzer, AH. Assessment of continuous acoustic respiratory rate monitoring as an addition to a pulse oximetry-based patient surveillance system. J Clin Monit Comput 2017;31(3):561–91.Google Scholar

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