Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial

BMC Anesthesiology

Research

Sergio D. Bergese¹  Toby N. Weingarten²  Mariana L. Laporta²  C. Noelle Driver²  Anthony G. Doufas³  Richard D. Urman⁴  Marco Scardapane⁵  Fabio Di Piazza⁵  Ashish K. Khanna⁶ 

[1] Department of Anesthesiology and Neurological Surgery, Stony Brook University School of Medicine, Stony Brook, New York, USA;Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA;Department of Anesthesiology, Perioperative and Pain Medicine, Center for Sleep and Circadian Sciences, Stanford University School of Medicine, 300 Pasteur Drive, H3580, Stanford, 94305-5640, San Francisco, CA, USA;Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, OH, USA;Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy;Section On Critical Care Medicine, Department of Anesthesiology, Wake Forest Center for Biomedical Informatics, Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA;Outcomes Research Consortium, Cleveland, OH, USA;

关键词: Respiratory depression;    Apnea;    Supplemental oxygen;    Room air;    Capnography;    Pulse oximetry;    Continuous monitoring;    Spot check monitoring;   

DOI  :  10.1186/s12871-023-02291-x

 received in 2023-06-20, accepted in 2023-09-22,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundSupplemental oxygen (SO) potentiates opioid-induced respiratory depression (OIRD) in experiments on healthy volunteers. Our objective was to examine the relationship between SO and OIRD in patients on surgical units.MethodsThis post-hoc analysis utilized a portion of the observational PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial dataset (202 patients, two trial sites), which involved blinded continuous pulse oximetry and capnography monitoring of postsurgical patients on surgical units. OIRD incidence was determined for patients receiving room air (RA), intermittent SO, or continuous SO. Generalized estimating equation (GEE) models, with a Poisson distribution, a log-link function and time of exposure as offset, were used to compare the incidence of OIRD when patients were receiving SO vs RA.ResultsWithin the analysis cohort, 74 patients were always on RA, 88 on intermittent and 40 on continuous SO. Compared with when on RA, when receiving SO patients had a higher risk for all OIRD episodes (incidence rate ratio [IRR] 2.7, 95% confidence interval [CI] 1.4–5.1), apnea episodes (IRR 2.8, 95% CI 1.5–5.2), and bradypnea episodes (IRR 3.0, 95% CI 1.2–7.9). Patients with high or intermediate PRODIGY scores had higher IRRs of OIRD episodes when receiving SO, compared with RA (IRR 4.5, 95% CI 2.2–9.6 and IRR 2.3, 95% CI 1.1–4.9, for high and intermediate scores, respectively).ConclusionsDespite oxygen desaturation events not differing between SO and RA, SO may clinically promote OIRD. Clinicians should be aware that postoperative patients receiving SO therapy remain at increased risk for apnea and bradypnea.Trial registrationClinicaltrials.gov: NCT02811302, registered June 23, 2016.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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