Common,
Costly, Deadly:
Postoperative
Respiratory
Compromise
Ruben D Restrepo, MD, RRT, FAARC
INITIATIVES Webinar Series
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INITIATIVES Webinar Series
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This educational module was made possible through an
unrestricted educational grant provided by Covidien.
Unless cited, the contents and conclusions of this course
are solely those of the course provider.
INITIATIVES Webinar Series
Our Speaker
Ruben Restrepo,
MD, RRT, FAARC
INITIATIVES Webinar Series
Disclosures
Planner and Speaker: Ruben D. Restrepo, MD, RRT, FAARC
Medical Advisory Board and Speaker — Teleflex Medical
Investigator and Speaker – Covidien
Advisory Board - Salter Labs
Investigator - Fisher & Paykel
Investigator – Hill Rom
Nurse Planner: Lisa Caffery, RN, MSN, CIC
Disclosures: No conflicts.
No off-label use of products are discussed in this webinar.
INITIATIVES Webinar Series
Common,
Costly, Deadly:
Postoperative
Respiratory
Compromise
Ruben D Restrepo, MD, RRT, FAARC
Ruben D Restrepo, MD, RRT, FAARC
INITIATIVES Webinar Series
Learning Objectives
• Define postoperative respiratory
compromise (PRC).
• Describe the overall impact of PRC.
• Review the current recommendations to
prevent PRC.
INITIATIVES Webinar Series
Outline
• Incidence of postoperative respiratory
complications
• Overall impact
• Risk factors
• Current guidelines on respiratory
monitoring
• How to reduce PRC
INITIATIVES Webinar Series
Postoperative Complications
• Postoperative Pulmonary Complications (PPCs)
• Preoperative
• Intraoperative
• Postoperative
• Postoperative Respiratory Compromise (PRC)
• Respiratory insufficiency
• Respiratory failure
• Respiratory arrest
INITIATIVES Webinar Series
Postoperative Pulmonary
Complications
Symptoms
• Fever (> 38oC)
• New-onset productive
cough
• Change in breath sounds
(rales or rhonchi)
• Tachypnea
• Dyspnea
• Altered mental status
Radiologic
• Atelectasis
• New infiltrates
Outcomes
• Prolonged postoperative
mechanical ventilation
(> 48 hr)
• Pneumonia
• Unplanned reintubation
Laboratory Values
• Hypoxemia
(PaO2 < 60 mm Hg on RA)
• Leukocytosis
• Microbiology of sputum
Branson RD. Respir Care. 2013;58:1974-1984.
INITIATIVES Webinar Series
Incidence of PPCs
• PPCs = 12.5% of all surgical proceduresatients1
• Annual incidence (2–40%)1
• Twice as common as postop cardiac complications
• Respiratory depression = 1.5% to 7%2-4
• By 2019, anticipate a 31.6% increase
(1.3 million cases)5
1.
2.
3.
4.
5.
Branson RD, Respir Care. 2013;58:1974-1984.
Smetana GW, Cleve Clin J Med. 2009;76:S60-5.
Dimick JB, J Am Coll Surg. 2004;199:531-537.
Hall RE, Am J Cardiol. 1997;79:1680-1682.
Agarwal SJ, Academy Health Congress, June 2011.
INITIATIVES Webinar Series
Incidence of and Risk Factors for Pulmonary
Complications after Nonthoracic Surgery
• 1,055 June 2001 – October 2003
• 321 inguinal hernia repairs
• 238 orthopedic limb surgeries
• 92 upper abdominal surgeries
• 28 suffered a PPC within 7 days of surgery
• 13 developed respiratory failure
• 9 contracted postoperative pneumonia (1 died)
• 5 cases of atelectasis
• 1 pneumothorax
• LOS 27.9 days vs. 4.5 days (p = 0.006)
McAlister FA, et al. AJRCCM. 2005;171:514-517.
INITIATIVES Webinar Series
Association between Preoperative/Operative Variables
and the Occurrence of Postoperative Pulmonary
Complications
Variable
n
OR (95% CI)
p Value
Age > 65 years
332
5.73 (2.49-13.15)
< 0.001
Sx > 2.5 hours
321
5.07 (2.27-11.33)
< 0.001
Perioperative NG tube
66
13.50 (6.08-29.96)
< 0.001
Upper abdominal incision
92
4.49 (1.92-10.50)
< 0.002
Positive cough test,
smoked >40 pack-years,
hx of COPD,
FEV > 9 sec,
daily productive cough
353
2.71–4.28
0.01–0.04
McAlister FA, et al. AJRCCM. 2005;171:514-517.
INITIATIVES Webinar Series
ACP systematic review of Postoperative Pulmonary
Complications after Noncardiothoracic Surgery
PPCs
Level of Evidence
PPCs
Reintubation
Prolonged intubation
Pneumonia
I; good
Results
20% vs. 17%
0-2.9%
7-22%
0-2.8%
Respiratory failure
Overall infection
I; fair
30% in IV group; 23% epidural
47% in IV group; 43% epidural
Death
Respiratory failure
Pneumonia
I; fair
4% vs. 3%
10% epidural vs. 14% IV
5% epidural vs. 8% IV
Pneumonia
Lobar atelectasis
Respiratory failure
I; fair
Overall PPCs: 16% epidural; 23% IV
Atelectasis
Pneumonia
Respiratory failure
I; poor
23% epidural vs. 18%
3% vs. 3%
I; poor
20% epidural vs. 28% IV; 40% IM morphine
4% epidural vs. 20% IV; 24% IM morphine
Lung expansion therapy: IS; deep-breathing exercises; CPAP
Lawrence VA, et al. Ann Intern Med. 2006;144:596-608.
INITIATIVES Webinar Series
Overall Impact of PPCs
• Increased morbidity and mortality
• Increased length of stay
• Lack of rapid identification
INITIATIVES Webinar Series
Clinical Burden
• Increased mortality
• 300-fold increase in 30-day mortality1
• 147-fold increase in abdominal reconstruction2
• Failure to wean vs. complication-free patients3
• 30-day mortality = 29% vs. 2%
• 1-year mortality = 56% vs. 9%
• 5-year mortality = 78% vs. 42%
1. Gupta PK, et al. Head Neck. 2012;34:321-327.
2. Fischer JP. Plastic Reconstr Surg. 2013;132:826e-5e.
3. Khuri SF, Ann Surg. 2005;242:326-341.
INITIATIVES Webinar Series
Clinical Burden
• Twice the number of readmissions within
30 days1
• 87% reduction in median survival in
patients with PPC2
• Precipitating cause of cardiac arrest
1. Sigl JC, et al. Annual Meeting of the ASA 2010:A859.
2. Khuri SF, et al. Ann Surg. 2005;242:326-341.
INITIATIVES Webinar Series
Clinical Burden of Respiratory
Insufficiency
• 2010 AHRQ statistical brief
• Respiratory insufficiency, arrest and failure (RIAF) is one of the
five conditions resulting in the most rapidly increasing hospital
costs for Medicare-covered stays in the U.S.1
• Inpatients with RIAF originate on the general care floor.
• Higher mortality rates (34.6%) than non-RIAF cases (1.2%) 2
• Postoperative respiratory failure has become a hospital
focus under Medicare’s Inpatient Quality Reporting
Program (Patient Safety Indicator #11).1
1. Wier LM, Healthcare Cost and Utilization 2010.
2. Zhan C, Miller MR. JAMA. 2003;290:1868-1874:764.
INITIATIVES Webinar Series
Cost of Care
• PPC case attributable cost = $52,0001
• $1.05 billion to $23.5 billion2-3
• In 2007, RIAF were related to 385,800 inpatient stays
costing $7.7 billion.3
• Significantly longer LOS (2 days longer than cardiac
complications)2
• Inpatients with RIAF originate on the general care floor
• Longer lengths of hospital and ICU stays than non-RIAF cases
(11.5 vs. 5.8 days and 4.1 vs. 2.9 days, respectively).5
1.
2.
3.
4.
5.
Dimick JB, et al. J Am Coll Surg 2004;199(4):531-537.
Wier LM, et al. AHRQ Brief #91. June 2010.
Reed K, May R. 7th Annual HealthGrades Patient Safety in US Hospitals. June 2010.
Lawrence VA, et al. J Gen Intern Med. 1995;10:671-678.
Wi Kelley SA, Crit Care Med 2012;40:764.
INITIATIVES Webinar Series
Risk Factors
Preoperative
• Age > 50 years
• ASA class > 2
• Liver disease
• Congestive heart failure
• Cancer
• COPD
• Cigarette use
• Obesity
• OSA
• Impaired sensorium
• Corticosteroid use
• Alcohol use
Intraoperative
• Surgery longer than 3 hr
• Emergency surgery
• Perioperative blood transfusion
• General anesthesia
• Use of NMB agents
• Type of surgery
•
•
•
•
•
•
Open aortic resection
Head and neck surgery
Upper abdominal surgery
Thoracic surgery
Neurosurgery
High tidal volume
Branson RD. Respir Care. 2013;58:1974-1984.
INITIATIVES Webinar Series
Patients at Risk for Respiratory
Compromise
• Postoperative Patients (includes all high-risk
patients) Advanced age
•
Organ system dysfunction
•
Concurrent CNS depressant use
•
Preoperative chronic opioid tolerance
• Obesity
•
•
Body needs more oxygen
Increased weight = increased work of breathing
Weinger M, Lee L. APSF Newsletter. 2011;26(2):21-40.
INITIATIVES Webinar Series
Patients at Risk for
Respiratory Compromise (cont’d)
• Obstructive sleep apnea (OSA)
•
2% in women and 4% in men; majority are undiagnosed1
•
High prevalence of OSA patterns after surgery, usually due
to narcotics2
•
Increased risk on days 2-3 (less monitoring, less pain,
increased sleep)3
• Opioid usage
•
Directly depresses the central respiratory drive
•
Fear of respiratory depression is one of the major barriers to
effective use of opioids to manage post-op pain4
1.Mirrakhimov AE, et al. BMC Pulm Med. 2013;13:10.
2.Blake DW, et al. Anaesth Intensive Care. 2009;37:720-725.
3.Parikh SN, et al. J Arthroplasty. 2002;17(5):635-642.
4.Brockopp D, et al. Int J Nurs Stud. 1998;35:226-232.
INITIATIVES Webinar Series
Intraoperative Factors
Anesthesia
Decreased cortical response – lower drive
Loss of muscle tone
Loss of airway patency
Suppression of neural and muscular activity
Reduced response to asphyxia
Branson RD. Respir Care. 2013;58:1974-1984.
INITIATIVES Webinar Series
How to Reduce PPC?
INITIATIVES Webinar Series
Meta-Analyses and RCT of Lung
Expansion Interventions to Prevent PPCs
Author, Year
Type of Sx
Intervention
Studies/RCT
Thomas and McIntosh, 1994
Upper abdominal
IS, IPPB, DBEs
116/14
Overend, 2001
Upper and lower
abdominal
IS, IPPB, DBEs, CPAP,
PEP, or CPAP with PT
85/4
Chumillas et al, 1998
Upper abdominal
DBEs vs. no prophylaxis
Fagevik Olsen et al, 1997
abdominal
DBEs vs. no prophylaxis
DBEs + PEP vs. no p.
Hall et al, 1991
abdominal
IS, CPT
Hall et al, 1996
abdominal
IS v. DBEs
IS vs. IS + CPT
Intra-abdominal vascular
NCPAP 12h vs. NC
Bonner et al, 2002
Lawrence VA, et al. Ann Intern Med. 2006;144:596-608.
INITIATIVES Webinar Series
Meta-Analyses and RCT of Lung Expansion
Interventions to Prevent PPCs
n
PPCs/Outcomes
Level of
Evidence
Intervention (n of studies) Results
1337
Atelectasis or infiltrate
I; poor
Is vs. no Tx (2) OR 0.44; 95% CI .18-.99
IS vs. IPPB (3) OR 0.73; 95% CI .39-1.36
IS vs. DBE (4) OR 0.91; 95% CI .57-1.4
IPPB vs. DBE (2) OR 0.94; 95% CI .28-3.17
81
Bronchitis, atelectasis,
pneumonia
I; poor
DBE Fewer CXR abnormalities (15% vs. 39%; p=0.02)
Fewer PPCs (8% vs. 20%; p=0.11)
368
Pneumonia
I; poor
DBE 0.6% vs. 7% no Tx; p<0.05
876
Abnormal CXR and
microbiology sputum
I; poor
IS vs. CPT (NSD) CXR (16% vs. 15%); PPCs (22% both)
456
Abnormal CXR and
microbiology sputum
I; poor
IS vs. CPT PPCs (8% vs. 11%); p=0.50
I; good
NCPAP vs. conventional
Hypoxemia 5% vs. 16%; p=0.01
Pneumonia 2% vs. 5%; p=0.45
Reintubation 1% vs. 5%; p=0.21
204
Pneumonia, severe hypoxemia
Lawrence VA, et al. Ann Intern Med. 2006;144:596-608.
INITIATIVES Webinar Series
Strength of Evidence for Specific
Interventions to Reduce Risk of PPCs
Strategy
Strength of
Evidence
Type of Complication Studied
Lund expansion modalities
A
Atelectasis, pneumonia, bronchitis, severe
hypoxemia
Postoperative NG
decompression
B
Atelectasis, pneumonia, aspiration
Short-acting NMB
B
Atelectasis, pneumonia
Laparoscopic vs. open operation
C
Spirometry, atelectasis, pneumonia
Smoking cessation
I
Postoperative ventilatory support
Routine parenteral/enteral
nutrition
D
Atelectasis, pneumonia, empyema, RF
Lawrence VA, et al. Ann Intern Med. 2006;144:596-608.
INITIATIVES Webinar Series
I COUGH: a Multidisciplinary Patient Care
Program to Reduce PPCs
1. Incentive spirometry
2. Coughing and deep breathing
3. Oral care (brushing teeth and using mouthwash
daily)
4. Understanding (patient and family education)
5. Getting out of bed frequently (3 times daily)
6. Head-of-bed elevation
Cassidy MR, et al. JAMA Surg. 2013;148:740-745.
INITIATIVES Webinar Series
Before and After I COUGH: Pneumonia Risk
Pneumonia raw data from BMC %
Pneumonia raw data from comparable hospitals %
Pneumonia risk-adjusted BMC (CE ratio or CR)
I COUGH
Transition
After
I COUGH
3.0
3.0
2.5
2.5
2.0
2.0
1.5
1.5
2.0
2.0
0.5
0.5
July 2008 to
June 2009
CY 2009
July 2009 to
June 2010
CY 2010
Risk-Adjusted Ratio (OE Ratio or OR)
Raw Data %
Before
I COUGH
July 2010 to
June 2011
Cassidy MR, et al. JAMA Surg. 2013;148:740-745.
INITIATIVES Webinar Series
Before and After I COUGH: Risk of Unplanned
Intubation
Unplanned intubation raw data from BMC %
Unplanned intubation raw data from comparable hospitals %
Unplanned intubation risk-adjusted BMC (OE ratio or OR)
I COUGH
Transition
After
I COUGH
2.3
2.3
2.0
2.0
1.7
1.7
1.4
1.4
1.1
1.1
0.8
0.8
0.5
0.5
July 2008 to
June 2009
CY 2009
July 2009 to
June 2010
CY 2010
Risk-Adjusted Ratio (OE Ratio or OR)
Raw Data %
Before
I COUGH
July 2010 to
June 2011
Cassidy MR, et al. JAMA Surg. 2013;148:740-745.
INITIATIVES Webinar Series
How to Reduce PRC?
• Comprehensive and rigorous monitoring strategy
• 77% records missing a vital sign11
• Respiratory rate — least documented VS
• Delayed interventions occur in 50% of patients with respiratory
distress, with a median duration of delay of 12 hr.2
• Early detection of RC determines success of interventions32
• Reduces rescue calls
• Reduces ICU admissions
• Higher risk for PRC in first 24 hours4
1.
2.
3.
4.
Chen J, et al. Resuscitation. 2009;80:35-43.
Quach JL, et al. J Crit Care. 2008;23:325-331.
Taenzer AH, Anesthesiology. 2010;112:282-287.
Taylor S, et al. Am J Surg. 2005;190:752-756.
INITIATIVES Webinar Series
Continuous Monitoring of
Respiratory Function
Purpose: Notifies medical professionals of conditions which may, if
unaddressed, lead to adverse events.
• The Anesthesia Patient Safety Foundation recommends that health
care professionals “consider the potential safety value of continuous
monitoring of oxygenation and ventilation in patients receiving PCA or
neuraxial opioids in the postoperative period.”1
• In patients undergoing PCA, continuous oximetry and capnography
monitoring reveal frequent desaturation and bradypnea.2
• Continuous monitoring with pulse oximetry provides early detection of
physiological decline, reducing rescue events & ICU transfers.3
1. Weinggarten TN, et al. Curr Opin Anaesthesiol. 2013;26:116-125.
2. Overdyk FJ, et al. Anesth Analg. 2007;105(2):412-418.
3. Taenzer AH, Anesthesiology. 2010;20-28.
INITIATIVES Webinar Series
Monitoring Guidelines
Organization
Continuous SpO2 for
patient at risk for RC
ASA
APSF
ASPMN
JC
X
X
X
X
X
X
X
Continuous capnography for
patients at risk for RC
Continuous monitoring by
telemetry may be used
X
X
ASA = American Society of Anesthesiologists
APSF = Anesthesia Patient Safety Foundation
ASPMN = American Society for Pain Management Nursing
JC= Joint Commission
INITIATIVES Webinar Series
Respiratory Rate (RR)
• Respiratory abnormalities are the most common
prior to ICU admission1
• Abnormal RR = strong predictor of in-hospital
mortality2
1. Peberdy MA, et al. JAMA. 2008;299:785-792.
2. Buist M, et al. Resuscitations 2004;62:137-141.
INITIATIVES Webinar Series
Association Between Clinically Abnormal
Observations and Subsequent In-hospital
Mortality: a Prospective Study
RR<6 / min
M.Buist et al./ Resuscitation 62 (2004) 137-141
Decrease of consciousness
Loss of consciousness
Fitting
Tachypnea
Bradycardia
Hypertension
Tachycardia
Hypotension
SaO2<90%
0
10
20
30
40
50
60
Percent of Total
Buist M, et al. Resuscitations 2004;62:137-141.
INITIATIVES Webinar Series
Association Between Clinically Abnormal
Observations and Subsequent In-hospital
Mortality: A Prospective Study
40
30
20
10
0
Independent Predictors of Mortality
Buist M, Resuscitation 2004;62(2):137-141 .
Event
Odds Ratio (95% CI)
Bradypnea (RR < 6)
14.4 (2.6 - 80.0)
Tachypnea (RR > 30)
7.2 (3.9 - 13.2)
Loss of consciousness
6.4 (2.9 - 13.6)
Decrease of consciousness
6.4 (2.6 - 15.7)
Hypotension
2.5 (1.6 - 4.1)
Hypoxemia (SpO2 < 90%)
1
2
2.4 (1.6 - 4.1)
3
4
100
80
60
40
20
0
Number of abnormal observations
Extremes of respiration rate are strong predictors of
in-hospital mortality on the general ward.
Buist M, et al. Resuscitations 2004;62:137-141.
INITIATIVES Webinar Series
Percent of mortality
Prevalence (%)
50
Respiratory Rate (RR)
• Respiratory abnormalities are the most common
prior to ICU admission1
• Abnormal RR = strong predictor of inhospital
mortality2
• Strongest predictor of ICU admission (> 35 bpm)3
• OR 9.1 (95% CI, 3.5–23.8)2
1. Peberdy MA, et al. JAMA. 2008;299:785-792.
2. Buist M, et al. Resuscitation. 2004;62:137-141.
3. Barford C, et al. Scand J Trauma Resusc Emerg Med. 2012;20-28.
INITIATIVES Webinar Series
Monitoring Devices
• Oxygenation
• Ventilation
INITIATIVES Webinar Series
Pulse Oximetry
Image provided by R. Restrepo
INITIATIVES Webinar Series
Continuous SpO2
• Reduces ICU stay and estimated cost of ICU care
• Postoperative hypoxemia
• SpO2 < 90% for at least 30 seconds
• SpO2 alarms (90% and 10 sec) wireless pager
violations1,2
• ≈ 75% reduction of rescue events
• ≈ 50% reduction in ICU transfers
1. Ochroch EA, et al. Anesth Analg. 2006;102:868-875.
2. Taenzer AH, et al. Anesthesiology. 2010;112:282-287.
INITIATIVES Webinar Series
Pulse Oximetry for Perioperative Monitoring
Hypotheses tested:
• Use of pulse oximetry is associated with improvement in
detecting and treating hypoxemia.
• Early detection and treatment of hypoxemia reduces
morbidity and mortality in the perioperative period.
• Use of pulse oximetry per se reduces morbidity and
mortality in the perioperative period.
• Use of pulse oximetry reduces unplanned respiratory
admissions to the ICU, decreases the length of ICU
readmission, or both.
Pedersen T, et al. Cochrane Database Syst Rev. 2014;3:CD002013.
INITIATIVES Webinar Series
Pulse Oximetry for Perioperative
Monitoring
Implications for practice:
•
The proliferation of monitors in anesthesia is obvious.
•
The goal of monitoring as an adjunct to clinical decision making is
to directly reduce the incidence of complications.
•
Unambiguous, accurate information helps clinicians choose and
initiate correct therapeutic interventions.
•
The human factor—the individual clinician’s action—is perhaps far
more important than implementing new monitoring equipment or
other new safety initiatives in situations where we wish to reduce
the rate of postoperative complications.
•
Can pulse oximetry protect against the human factor?
Pedersen T, et al. Cochrane Database Syst Rev. 2014;3:CD002013.
INITIATIVES Webinar Series
Pulse Oximetry for Perioperative
Monitoring
Implications for practice:
•
SpO2 monitoring substantially reduced the extent of perioperative
hypoxemia.
•
SpO2 enabled the detection and treatment of hypoxemia and
related respiratory events and promoted several changes in patient
care.
•
The implementation of perioperative pulse oximetry monitoring
was not, however, the breakthrough that could reduce the number
of postoperative complications.
•
The data suggest that there may be a benefit for a population at
high risk of postoperative pulmonary complications.
Pedersen T, et al. Cochrane Database Syst Rev. 2014;3:CD002013
INITIATIVES Webinar Series
Why Capnography?
Because ventilation and oxygenation
are VERY different concepts.
Image provided by R. Restrepo
Image
INITIATIVES Webinar Series
Oxygenation and Ventilation
The process of
getting O2 into
the body
Ventilation
Oxygenation
2-separate
physiologic
processes
Provided by permission from Covidien
The process of
eliminating CO2
from the body
INITIATIVES Webinar Series
Important but Different Measurements
etCO2
• Reflects ventilation
• AH and apnea
detected immediately
SpO2
• Reflects oxygenation
• Values lag with AH and
apnea
“Cases of respiratory depression were 28 times as likely to
be detected, if they were monitored by capnography, as
those who were not monitored.”
“… end tidal carbon dioxide monitoring is an important
addition to oximetry for detecting respiratory depression.”
Waugh J, et al. Respir Care. 2007;52(11)
INITIATIVES Webinar Series
Oxygenation vs. Ventilation
Now hold your breath...
Note what happens to
the 2 waveforms
How long did it take the EtCO2 waveform to go flat line?
How long did it take the SpO2 to drop below 90%?
INITIATIVES Webinar Series
Continuous EtCO2
• May provide earliest indicator of RC
• Hypercapnia can occur with normal SpO2
• ASA recommends capnography for deeply sedated
patients
• Overdyk (2007)
• 178 patients received PCA
• SpO2 < 90% = 12%
• RR < 10 x 3 min (41%) and x 2 min (58%)
Overdyk FJ, et al. Anesth Analg. 2007;105(2):412-418.
INITIATIVES Webinar Series
Capnography
CO2
(mmHg)
Slow respirations – opioid/
sedative effect
40
0
Time
CO2
(mmHg)
Shallow, irregular breathing –
partial airway obstr. (OSA
40
0
Time
CO2
(mmHg)
40
Rebreathing
0
Time
CO2
(mmHg)
40
Apnea, agonal
breathing
0
Time
Graphs provided by R. Restrepo
INITIATIVES Webinar Series
SpO2 plus EtCO2
• PCA patients
• 65% reduction in overall adverse effects and cost
• Obstacles to implementation
• Alarm fatigue (95% of hospitals surveyed)
• Single monitor preferred (71%)
Wong M, et al. Physician-Patient Alliance for Health and Safety. 2013.
INITIATIVES Webinar Series
Image provided courtesy of Covidien
1. Linde-Zwirble WL, Bloom JD, Mecca RS, Hansell DM. Postoperative pulmonary complications in adult elective surgery patients in the US: severity, outcome and resources use. Crit
Care Med. 2010;14: P210. 2. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, 2019. Abstract
presented at Academy Health Congress, June 2011. 3. Wier LM, Henke R, Friedman B. Diagnostic Groups with Rapidly Increasing Costs, by Payer, 2001 -2007. Healthcare Cost and
Utilization Project. Agency for Healthcare Research and Quality. Statistical Brief #91. June 2010. Available at: http://ww.hcupus.ahrq.gov/reports/statbriefs/sb91.pdf 4. Kelley SD, Agarwal
S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012;40(12):764.
INITIATIVES Webinar Series
Conclusion
1. Respiratory compromise is common, costly, and
deadly.
2. Current monitoring regimens may be inadequate for
preventing respiratory compromise and other adverse
events.
3. Current monitoring practices are inconsistent and
suboptimal.
4. Adverse events are frequently preceded by respiratory
abnormalities.
5. Continuous monitoring of respiratory function provides
notification to the medical professional of conditions
which may, if unaddressed, lead to adverse events.
INITIATIVES Webinar Series
Continuing Education
• This activity has been approved for 1.0 contact hour of
CRCE and CNE.
• At the end of this webinar, you can obtain those
continuing education credits by logging on to
www.saxetesting.com/init
• Complete the post-test and evaluation form.
• Upon successful submission, you will be able to print
your certificate of completion.
Accreditation
American Association for Respiratory Care, 9425 N. MacArthur Blvd., Suite 100, Irving, TX 75063.
Saxe Communications is an accredited provider of continuing education by the American Nurses Credentialing Center
(ANCC)
Provider (Saxe Communications) is approved by the California Board of Registered Nursing. Provider # 14477
INITIATIVES Webinar Series
This webinar has been recorded and will be archived
on www.initiatives-patientsafety.org for on-demand
viewing. You can also obtain CE/CRCEs
for viewing and completing the
on-demand webinar.
INITIATIVES Webinar Series
Questions & Answers
INITIATIVES Webinar Series