The Science Journal of the American Association for Respiratory Care

2010 OPEN FORUM Abstracts

ETCO2 MONITORING IN THE POST-OPERATIVE SURGICAL PATIENT

Cory Daniels; Lakeland Regional Medical Center, Lakeland, FL

Lakeland Regional Medical Center Cory Daniels BS, RRT-NPS Advanced Practice Specialist Background: Does capnography monitoring via EtCO2 nasal cannula on post-operative (total knee and total hip) surgical patients improve patient safety with patients receiving patient-controlled analgesia/opioids? This study aims to increase patient safety by decreasing the number of incidents of patients developing respiratory depression post-operatively using capnography monitoring via EtCO2 nasal cannula. Method: A quasi-experimental design was used to study 32 patients who were screened pre-operatively and did/did not score out as high-risk patients (Score >= 5) for developing respiratory depression post-operatively. All patients were automatically placed on capnography monitoring regardless of pre-screening tool score. JMP software was utilized to analyze the data. We measured patient safety in the following ways: Use of opioid reversal agent Narcan (opioid antagonist). If the Critical Care Assessment Team (CCAT) was called to evaluate the patient. Track number of “high EtCO2 alarms, >= 60mmHg ” (alarms with alerts of possibility of respiratory depression) on the capnography monitor. These monitors have the ability to store and download all alarms within a 24 hour period. Results: The following data was collected during the study: Total males = 8 Total females = 24 Participants who met criteria = 9 % of total who met criteria = 28% Mean age = 66.50 Mean screening tool score = 3.22 Total number of hips = 8 Total number of knees = 24 Total number of high (>= 60mmHg) EtCO2 events that occur within 24 hours post-operatively = 71 independent episodes (episodes > 10 minutes apart from one another) Total opioid reversal agents (Narcan) used = 0 Total Critical Care Assessment Team interventions = 0 Conclusions: 28% of patients scored using the pre-screening tool met criteria for developing respiratory depression post-operatively. Screening tool predicted with 94% accuracy patients who would develop elevated EtCO2 >= 45mmHg. An astonishing number (71 events) of high (>= 60mmHg) EtCO2 occurred within 24 hours post-operatively. EtCO2 as high as 96mmHg 16 to 24 hours post-operatively on one patient was noted. Sponsored Research - None

Pre-Operative Screening Tool

Score the patient based on the scale below. A score of “5 or higher” indicates a “positive” screen. (These patients are high-risk for Respiratory Depression/Obstructive Sleep Apnea)