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J Patient Saf. 2017 Jul 20. doi: 10.1097/PTS.0000000000000408. [Epub ahead of print]

Continuous Capnography Reduces the Incidence of Opioid-Induced Respiratory Rescue by Hospital Rapid Resuscitation Team.

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1
From the Departments of *Nursing, †Quality & Safety, ‡Respiratory Therapy Services, The University of Kansas Hospital; and §Department of Anesthesiology, Kansas University Medical Center, Kansas City, Kansas.

Abstract

OBJECTIVE:

The aim of this study was to determine 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.

METHODS:

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.

RESULTS:

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 (χ = 46.246; df, 1; 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).

CONCLUSIONS:

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.

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