Continuous Monitoring Detected Respiratory Depressive Episodes in Proximity to Adverse Respiratory Events During the PRODIGY Trial.

Content Provider	Europe PMC
Author	Kor, Jennifer J. Sprung, Juraj Khanna, Ashish K. Weingarten, Toby N.
Copyright Year	2022
Abstract	PurposeThe PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial was a multicenter prospective trial conducted to develop a risk prediction score for opioid-induced respiratory depressive (OIRD) episodes. Several subjects in the PRODIGY trial developed critical respiratory depressive events, which were qualified as reportable adverse events (AEs). In this study, we determine whether those patients also had an episode of OIRD as detected by continuous capnography and pulse oximetry leading up to the critical clinical event.MethodsBlinded capnography and pulse oximetry data from PRODIGY patients who had critical respiratory depressive AE were reviewed. The occurrence and timing of OIRD episodes were recorded in relationship to the AE.ResultsOf the 1335 subjects in PRODIGY, 7 patients had 8 reportable pulmonary AE and 187 OIRDs (150 apnea episodes, 14 bradypnea episodes, 23 hypoxic episodes) with median 12 (5–19.5) OIRDs per patient. Five patients were monitored before the AE, and multiple preceding OIRD episodes were detected. One patient had 2 AE, the first (hypoxemia) was recognized upon application of pulse oximetry. This patient subsequently had multiple OIRDs until the second AE occurred (somnolence requiring naloxone administration). Another patient’s AE (hypotension and bradypnea) was recognized upon monitor application and subsequently had many OIRD episodes.ConclusionsIn the PRODIGY trial, patients who had a pulmonary AE had multiple preceding OIRDs detected by continuous capnography and pulse oximetry. When monitoring was initiated before the AE, numerous OIRDs, mostly apneic episodes preceded AE, suggesting continuous monitoring of both ventilation and oxygenation may allow for early detection and possible prediction of future clinical decompensation.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC9698081&blobtype=pdf
ISSN	15498417
Journal	Journal of Patient Safety [J Patient Saf]
Volume Number	18
PubMed Central reference number	PMC9698081
Issue Number	8
PubMed reference number	35405725
e-ISSN	15498425
DOI	10.1097/pts.0000000000001003
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2022-04-27
Access Restriction	Open
Rights License	This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.
Subject Keyword	respiratory depression opioid analgesia capnography
Content Type	Text
Resource Type	Article
Subject	Leadership and Management Public Health, Environmental and Occupational Health