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Randomized Controlled Trial
. 2021 Oct;35(5):1093-1102.
doi: 10.1007/s10877-020-00564-1. Epub 2020 Jul 29.

Postoperative respiratory state assessment using the Integrated Pulmonary Index (IPI) and resultant nurse interventions in the post-anesthesia care unit: a randomized controlled trial

Suzanne J L Broens  1   2 , Susan A Prins  1 , Dorinne de Kleer  1 , Marieke Niesters  1 , Albert Dahan  1 , Monique van Velzen  3   4
Affiliations
Randomized Controlled Trial

Postoperative respiratory state assessment using the Integrated Pulmonary Index (IPI) and resultant nurse interventions in the post-anesthesia care unit: a randomized controlled trial

Suzanne J L Broens et al. J Clin Monit Comput. 2021 Oct.

Abstract

Although postoperative adverse respiratory events, defined by a decrease in respiratory rate (RR) and/or a drop in oxygen saturation (SpO2), occur frequently, many of such events are missed. The purpose of the current study was to assess whether continuous monitoring of the integrated pulmonary index (IPI), a composite index of SpO2, RR, end-tidal PCO2 and heart rate, alters our ability to identify and prevent adverse respiratory events in postoperative patients. Eighty postoperative patients were subjected to continuous respiratory monitoring during the first postoperative night using RR and pulse oximetry and the IPI monitor. Patients were randomized to receive intervention based on standard care (observational) or based on the IPI monitor (interventional). Nurses were asked to respond to adverse respiratory events with an intervention to improve the patient's respiratory condition. There was no difference in the number of patients that experienced at least one adverse respiratory event: 21 and 16 in observational and interventional group, respectively (p = 0.218). Compared to the observational group, the use of the IPI monitor led to an increase in the number of interventions performed by nurses to improve the respiratory status of the patient (average 13 versus 39 interventions, p < 0.001). This difference was associated with a significant reduction of the median number of events per patient (2.5 versus 6, p < 0.05) and a shorter median duration of events (62 s versus 75 s, p < 0.001). The use of the IPI monitor in postoperative patients did not result in a reduction of the number of patients experiencing adverse respiratory events, compared to standard clinical care. However, it did lead to an increased number of nurse interventions and a decreased number and duration of respiratory events in patients that experienced postoperative adverse respiratory events.

Keywords: Anesthesia; Apnea; Opioids; Respiratory depression; Respiratory monitoring.

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Figures

Fig. 1
Fig. 1
Study flow chart. CPAP continuous positive airway pressure, ICU intensive care unit, PACU post-anesthesia care unit
See this image and copyright information in PMC

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