Multiple underlying conditions may be responsible for evolving respiratory compromise.([FOOTNOTE=Lynn, L. A., & Curry, J. P. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5(1):3.],[ANCHOR=],[LINK=]) The likelihood for developing respiratory compromise may be influenced by a number of patient-specific or treatment-specific factors.([FOOTNOTE=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.],[ANCHOR=],[LINK=])
Changes in respiratory vital signs corresponding with respiratory compromise often precede in-hospital deterioration and are associated with increased mortality.([FOOTNOTE=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.],[ANCHOR=],[LINK=]) ([FOOTNOTE=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.],[ANCHOR=],[LINK=]) ([FOOTNOTE=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.],[ANCHOR=],[LINK=])-6 Many in-hospital declines may be preventable with better monitoring and early intervention to address evolving respiratory compromise.([FOOTNOTE=Sun, Z., Sessler, D. I., Dalton, J. E., et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth AnalgAnesthesiology. 2010;112(2):282-287.],[ANCHOR=],[LINK=]) ([FOOTNOTE=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.],[ANCHOR=],[LINK=]),8
Respiratory compromise imposes substantial burdens on patient health and hospital costs.([FOOTNOTE=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.],[ANCHOR=],[LINK=]) ([FOOTNOTE=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.],[ANCHOR=],[LINK=]),10
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.([FOOTNOTE=Weinger, M. B., & Lee, L. A. No Patient Shall Be Harmed By Opioid-Induced Respiratory Depression. APSF Newsletter. 2011;26(2):21.],[ANCHOR=],[LINK=]) Therefore, these patients may be at increased risk for respiratory compromise.
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. ([FOOTNOTE=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.],[ANCHOR=],[LINK=]) ([FOOTNOTE=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.],[ANCHOR=],[LINK=]),13
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.
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.
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,([FOOTNOTE=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.],[ANCHOR=],[LINK=]),([FOOTNOTE=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.],[ANCHOR=],[LINK=]),([FOOTNOTE=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.],[ANCHOR=],[LINK=]) offering clinicians the opportunity to provide care sooner and quickly determine how to intervene, reducing risk and saving time, money and lives.
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.