![]() ![]() Nonetheless, problems have been encountered with using capnography in non-intubated patients such as compliance with use, dislodgement of devices, false or “nuisance” alarms, and restricted patient mobility. However, in 2004 the introduction of new technology made it possible to use capnography efficiently to monitor patients who are not intubated in general care nursing units. 8,13-16 Earlier capnography systems required the patient’s trachea to be intubated, mostly limiting their use to critical care areas and the surgical suite. ![]() 12Ī growing body of literature shows that capnography is the earliest indicator of respiratory distress. 11 Thus, even continuous monitoring of heart rate and SpO 2 by pulse oximetry is not a substitute for monitoring RR, EtCO 2, and apneic events by capnography. 2 As a result, pulse oximetry may fail to detect respiratory deterioration, particularly if a patient is receiving supplemental oxygen, which delays the progression of respiratory failure from bradypnea to apnea. 11 Lethal hypercarbia is possible despite normal oxygen saturation. 10 Nurses usually are not available for continuous monitoring, and there is no automated alarm to alert nurses not in the room.Įven at a low RR, oxygen saturation is usually maintained. Manual counts have been shown to be inaccurate when compared to capnometry. 9 The nurse’s presence may stimulate the patient, resulting in overestimation of the resting RR, which is often determined by manual respiration counts. 8 Because patients vary greatly in their response to opioids, patient status can change quickly, and traditional approaches to respiratory monitoring are less than optimal.Ĭurrent monitoring protocols typically require nurses to document the RR and less commonly the oxygen saturation (SpO 2) value initially every 30 minutes, then as infrequently as every 2 to 4 hours. 4ĭetection of a patient’s declining respiratory status before progression to respiratory depression can help avert undesirable outcomes and transfer to an ICU. 5-7 The use of continuous capnography monitoring yielded the following incidences: respiratory depression based on bradypnea, defined traditionally (≥1, two-minute or longer low-RR event ) was 58% defined conservatively (≥1, three-minute or longer low-RR event) was 41%. 4 However, the incidence of respiratory depression as measured by bradypnea was far greater than the 1 to 2% reported in the literature. The incidence of respiratory depression as measured by oxygen desaturation was 12%, consistent with previous estimates. used both pulse oximetry and non-invasive capnography to continuously monitor 178 patients receiving PCA therapy. In particular, the value of using capnography to measure not only respiratory rate (RR) but also end-tidal carbon dioxide (EtCO 2) is not well recognized. ![]() Most general-care clinicians are not as familiar with this type of monitoring as they are with pulse oximetry. Until recently capnography monitoring could only be used with intubated patients in the operating suite and intensive care unit (ICU). Conference participants generally recommended pulse oximetry for all patients receiving PCA therapy, and capnography only for those receiving supplemental oxygen. 2 During the conference it was evident that there is a significant need for the anesthesia community to better understand and fully embrace the critical importance of continuous respiratory monitoring-particularly capnography in conjunction with, or as an alternative to, pulse oximetry when parenteral opioids are used in the postoperative period. In 2006 the ASPF first addressed the issue of drug-induced respiratory depression in the postoperative period, 1 and in June of 2011 convened its second conference to work toward mitigating and eventually eliminating this serious patient safety risk.
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