Multiple underlying conditions may be responsible for evolving respiratory compromise. Conditions that lead to respiratory compromise can be categorized by three physiological pathways: hypoxic respiratory failure, hypercapnic respiratory failure, and sleep disordered breathing related arousal failure.1
The main difference between respiratory insufficiency and respiratory failure is that respiratory insufficiency does not indicate that the respiratory system is completely unable to supply adequate oxygen to maintain metabolism and/or eliminate sufficient carbon dioxide to avoid respiratory failure.2 In contrast, respiratory failure is often defined as a respiratory condition requiring intervention such as mechanical ventilation or unplanned intubation, or use of naloxone.3
The likelihood for developing respiratory compromise may be influenced by a number of patient-specific or treatment-specific factors.
Discover below the common physiological pathways leading to respiratory compromise1 and which respiratory and monitoring solutions from Medtronic can help with the early identification of respiratory compromise.
|Hypoxic Respiratory Failure||Hypercapnic Respiratory Failure||Sleep Disordered Breathing Related Arousal Failure|
|Primary Issue||Decreasing ability to oxygenate blood due to congestion (e.g., fluid, pus, etc.) in lung tissue (alveoli).||Inadequate ventilation to clear carbon dioxide secondary to hypoventilation.||Failure of patient to initiate hyperventilatory ‘arousal response’ following sleep apnea related hypoventilation. Failure of arousal response is often related to opioid/sedative administration.|
Chest wall disorders
Obstructive sleep apnea
Central sleep apnea
|Precipitating Vital Signs||
↑ Respiratory rate
↑ Minute ventilation
↓ Blood CO2
SpO2 is maintained until precipitous drop at respiratory failure
Normal or ↓ respiratory rate
↑ Blood CO2
Lagging drop in SpO2
Due to plateau of oxyhemoglobin dissociation curve, SpO2 is maintained above 90% through a significant rise in CO. Further masked by use of supplemental oxygen
Sawtooth pattern of of drops and increases in RR and MV
Results in reciprocal sawtooth rises and falls in blood oxygen and CO2
Incidence of respiratory adverse events in moderate to deep procedural sedation is often underestimated, still reported in published clinical studies4 and its consequences may, even if rarely, lead to death.4
The outcomes pledge program by Medtronic will help you measure the incidence of adverse events in your own setting, with your own clinical team and your own protocols and assess the impact of capnography monitoring on the prevention of such events.
Multiple clinical studies have identified independent risk factors for respiratory compromise. Applicable risk factors may be altered by patient population or endpoint being investigated (e.g. respiratory failure, unplanned intubation, etc).
1. Lynn, L.A., & Curry, J.P. Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Saf Surg. 2011;5(1):3.
2. Health Information Associates. 2010. Respiratory failure diagnosis coding. Accessed online at https://www.hiacode.com/wp-content/uploads/2017/10/Respiratory-Failure-%E2%80%93-Clinical-Indicators-Treatment-Coding-and-Sequencing.pdf.
3. Ramachandran, S. K., Nafiu, O. O., Ghaferi, A., Tremper, K. K., Shanks, A., & Kheterpal, S. Independent predictors and outcomes of unanticipated early postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology. 2011;115(1):44-53
4. Leslie K, Allen ML, Hessian EC, Peyton PJ, Kasza J, Courtney A, et al. Safety of sedation for gastrointestinal endoscopy in a group of university-affiliated hospitals: A prospective cohort study. Br J Anaesth. 2017;118(1):90–9. https://pubmed.ncbi.nlm.nih.gov/28039246/
5. 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.
6. Weingarten, T. N., Herasevich, V., McGlinch, M. C., et al. Predictors of Delayed Postoperative Respiratory Depression Assessed from Naloxone Administration. Anesth Analg. 2015;121(2):422-429.
7. 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.
8. 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.
9. 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.