What is respiratory compromise?

Respiratory compromise is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure, respiratory arrest or death, but in which specific interventions (continuous monitoring and therapies) might prevent or mitigate decompensation.1

Why does respiratory compromise occur?

Multiple underlying conditions may be responsible for evolving respiratory compromise.2 The likelihood for developing respiratory compromise may be influenced by a number of patient-specific or treatment-specific factors.3

Why focus on respiratory compromise?

Changes in respiratory vital signs corresponding with respiratory compromise often precede in-hospital deterioration and are associated with increased mortality.4-6 Many in-hospital declines may be preventable with better monitoring and early intervention to address evolving respiratory compromise.7-8

What is the impact of respiratory compromise?

Respiratory compromise imposes substantial burdens on patient health and hospital costs.9-10

SURVEILLANCE MONITORING IN LOW ACUITY SETTINGS

Changes in patient populations, along with economic and practical considerations, have led to an overall increase in patient acuity on the general care floor (GCF). Despite the presence of higher risk patients, current GCF surveillance is often limited to isolated spot checks of core vital signs, such as heart rate, respiratory rate, blood pressure and temperature, with such observations often limited to every 4 hours, which leaves patients unmonitored 96% of the time.11 Therefore, these patients may be at increased risk for respiratory compromise.

Automated Early Warning Scores Systems

Evidence has demonstrated that the implementation of automated early warning score systems may improve patient outcome, and reduce the cost of implementation compared to traditional manually calculated systems.12-13

Vital Sync™ Monitoring and Clinical Decision Support (CDS) Solution

The Vital Sync™ monitoring and CDS solution integrates information from wearable and bedside devices and transmits it to a hospital server. This single software platform helps clinicians gain more value from their medical devices. The Vital Sync™ CDS solution allows clinicians to take action with immediate access to smart, actionable data, implement clinical protocols through use of CDS apps, view patient physiological information remotely, and receive updates and alerts on any web-enabled device.

Vital Sync™ Early Warning Score (EWS) App

This new clinical decision support (CDS) app helps hospitals realize the benefits of using an automated early warning system. The Vital Sync™ EWS app continuously monitors patient information from multiple bedside and wearable devices, EMRs, as well as data that has been manually entered by clinicians, to automatically calculate an early warning score based on your facility’s chosen algorithm. Clinicians know when the first signs of patient deterioration appear- so they can take the appropriate action.

Microstream™ Capnography

A clinician's time and resources are limited, but a patient’s needs are not. Microstream™-enabled capnography monitoring may provide an early warning of respiratory compromise,14-16 offering clinicians the opportunity to provide care sooner and quickly determine how to intervene, reducing risk and saving time, money and lives.

Nellcor™ Pulse Oximetry

The Nellcor™ pulse oximetry system with OxiMax™ technology establishes a new milestone in patient safety monitoring that can impact clinical settings from the everyday to the extraordinary. This new sensor design helps to more effectively monitor a broader range of patients, including those who may have been difficult to monitor in the past based on certain clinical considerations.

References

1. Respiratory Compromise Institute. http://www.respiratorycompromise.org/. 2017.

2. Lynn, L. A., & Curry, J. P. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5(1):3.

3. Alvarez, M. P., Samayoa-Mendez, A. X., Naglak, M. C., Yuschak, J. V., & Murayama, K. M. Risk Factors for Postoperative Unplanned Intubation: Analysis of a National Database. Am Surg. 2015;81(8):820-825.

4. Barfod, C., Lauritzen, M. M., Danker, J. K., et al. Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department - a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012;20:28.

5. Buist, M., Bernard, S., Nguyen, T. V., Moore, G., & Anderson, J. Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004;62(2):137-141.

6. Chaboyer, W., Thalib, L., Foster, M., Ball, C., & Richards, B. Predictors of adverse events in patients after discharge from the intensive care unit. Am J Crit Care. 2008;17(3):255-263; quiz 264.

7. Sun, Z., Sessler, D. I., Dalton, J. E., et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth Analg. 2015;121(3):709-715.

8. Taenzer, A. H., Pyke, J. B., McGrath, S. P., & Blike, G. T. Impact of pulse oximetry surveillance on rescue events and intensive care unit transfers: a before-and-after concurrence study. Anesthesiology. 2010;112(2):282-287.

9. Andersen, L. W., Berg, K. M., Chase, M., et al. Acute respiratory compromise on inpatient wards in the United States: Incidence, outcomes, and factors associated with in-hospital mortality. Resuscitation. 2016;105:123-129.

10. Wang, H. E., Abella, B. S., & Callaway, C. W. Risk of cardiopulmonary arrest after acute respiratory compromise in hospitalized patients. Resuscitation. 2008;79(2):234-240.

11. Weinger, M. B., & Lee, L. A. No Patient Shall Be Harmed By Opioid-Induced Respiratory Depression. APSF Newsletter. 2011;26(2):21.

12. Bellomo, R., Ackerman, M., Bailey, M., et al. A controlled trial of electronic automated advisory vital signs monitoring in general hospital wards. Crit Care Med. 2012;40(8):2349-2361.

13. Slight, S. P., Franz, C., Olugbile, M., Brown, H. V., Bates, D. W., & Zimlichman, E. The return on investment of implementing a continuous monitoring system in general medical-surgical units. Crit Care Med. 2014;42(8):1862-1868.

14. Cacho, G., Perez-Calle, J. L., Barbado, A., Lledo, J. L., Ojea, R., & Fernandez-Rodriguez, C. M. Capnography is superior to pulse oximetry for the detection of respiratory depression during colonoscopy. Rev Esp Enferm Dig. 2010;102(2):86-89.

15. Maddox, R. R., Oglesby, H., Williams, C. K., Fields, M., & Danello, S. (2008). Continuous Respiratory Monitoring and a "Smart" Infusion System Improve Safety of Patient-Controlled Analgesia in the Postoperative Period.

16. Overdyk, F. J., Carter, R., Maddox, R. R., Callura, J., Herrin, A. E., & Henriquez, C. Continuous oximetry/capnometry monitoring reveals frequent desaturation and bradypnea during patient-controlled analgesia. Anesth Analg. 2007;105(2):412-418.