Hypoventilation

Life-saving continuous monitoring of vulnerable breathing

Clinical Solutions2020-09-30T16:18:57+00:00
Clinical Need

Respiratory depression due to residual anesthetics may cause brain damage or death in a post-anesthesia care unit (PACU). Growing use of opioid and Propofol increases the risk of respiratory depression and arrest. Continuous monitoring of tidal volume and minute ventilation is needed to ensure better care for these non-intubated patients as well as patients with obesity hypoventilation syndrome (OHS), neuromuscular diseases, and chronic obstructive pulmonary disease (COPD).

References

  1. Postoperative Opioid-Induced Respiratory Depression: A Closed Claims Analysis. Lee LA, Caplan RA, Stephens LS, Posner KS, Terman GW, et al. Anesthesiology 2015; 122:659-65.
  2. Obesity Hypoventilation Syndrome: A Review of Epidemiology, Pathophysiology, and Perioperative Considerations. Chau EHL, LAM D, Wong J, Mokhlesi B, Chung F. Anesthesiology 2012; 117:188-205.
  3. Timing of Postoperative Respiratory Emergencies: When Do They Really Occur? Weingarten TN, Warner LL, Sprung J. Curr Opin Anesthesiol 2017; 30:156-162.
  4. Risk Factors for Opioid-Induced Respiratory Depression and Failure to Rescue: A Review. Gupta K, Prasad A, Nagappa M, Wong Jean, Abrahamyan L, Chung F. Curr Opin Anesthesiol 2018; 31:110-119.
  5. Opioids for Acute Pain Management in Patients with Obstructive Sleep Apnea: A Systematic Review. Cozowicz C, Chung F, Doufas AG, Nagappa M, Memtsoudis SG. Anesth Analg 2018; Epub ahead of print.
Current Practices

Spirometry and capnography require face masks or nasal cannulas. Capnography and SpO2 are slow to detect respiratory depression. Impedance pneumography lacks accuracy.

References

  1. Monitoring Hospitalized Adult Patients for Opioid-Induced Sedation and Respiratory Depression. Jungquist CR, Smith S, Nicely KLW, Polomano RC. American Journal of Nursing 2017; 117(5):S27-S35.
  2. Monitoring for Opioid-Induced Respiratory Depression. Gupta RK, Edwards DA. Anesthesia Patient Safety Foundation Newsletter 2018; 3:70-72.
  3. Continuous Pulse Oximetry and Capnography Monitory for Postoperative Respiratory Depression and Adverse Events: A Systematic Review and Meta-analysis. Lam T, Nagappa M, Wong J, Sing M, Wong D, Chung F. Anesth Analg 2017; 125:2019-29.
  4. Practice Guidelines for Postanesthetic Care: An Updated Report by the American Society of Anesthesiologists Task Force on Postanesthetic Care. Apfelbaum JL, Silverstein JH, Chung F, Connis RT, Fillmore RB, Hunt SE, Nickinovick DG, Schreiner MS, Barlow JC, Joas TA. Anesthesiology 2013; 118:291-307.
  5. Society of Anesthesia and Sleep Medicine Guidelines on Preoperative Screening and Assessment of Adult Patients with Obstructive Sleep Apnea. Chung F, Memtsoudis SG, Ramachandran SK, Nagappa M, Opperer M, Cozowicz C, Patrawala S, Lam D, Kumar A, Joshi GP, Fleetham J, Ayas N, Collop N, Goufas AG, Eikermann, M, Englesakis M, Gali B, Gay P, Hernandez AV, Kaw R, Kezirian EJ, Malhotra A, Mokhlesi B, Parthasarathy S, Stierer T, Wappler F, Hillman DR, Auckley D. Anaesth Analg 2016; 123:45-73.
Solution

BiLab provides a new method to quantify how much air fills the lungs in every breath. Using this state-of-the-art measurement technology, noninvasive real-time ventilation monitoring is now possible for patients with respiratory depression, OHS, neuromuscular diseases, and COPD. Tidal volume, minute ventilation, respiration rate, and inspiratory/expiratory times are measured using electrode pads around the chest.