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Clinical Trial
. 2023 Oct 4;23(1):332.
doi: 10.1186/s12871-023-02291-x.

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

Anthony G Doufas  1 , Mariana L Laporta  2 , C Noelle Driver  2 , Fabio Di Piazza  3 , Marco Scardapane  3 , Sergio D Bergese  4 , Richard D Urman  5 , Ashish K Khanna  6   7 , Toby N Weingarten  2 ; Prediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators
Collaborators, Affiliations
Clinical Trial

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

Anthony G Doufas et al. BMC Anesthesiol. .

Abstract

Background: Supplemental 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.

Methods: This 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.

Results: Within 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).

Conclusions: Despite 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 registration: Clinicaltrials.gov: NCT02811302, registered June 23, 2016.

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

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Conflict of interest statement

TNW, AKK, SDB, and RDU or their institutions received financial support from Medtronic to fund the original trial. In addition, TNW reports personal fees from Merck; RDU reports funding and/or personal fees from Merck, Medtronic, AcelRx, and Pfizer; AKK reports consulting fees from Medtronic, Edwards Lifesciences, Philips Research North America, GE Healthcare, Baxter, Retia Medical, Caretaker Medical, Trevena Pharmaceuticals, Renibus Therapeutics and support via an NIH/NCATS KL2 award for a trial of continuous portable monitoring on hospital general care floors. FDP and MS report full time employment with Medtronic during the time of the work. MLL, CND, and AGD declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of PRODIGY patients from 2 trial sites receiving supplemental oxygen during continuous monitoring. Abbreviations: PRODIGY = PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY; SO = Supplemental oxygen
Fig. 2
Fig. 2
Generalized estimating equation model for A the incidence rate ratio of respiratory depression episodes in patients during times of supplemental oxygen, compared with breathing room air, and B the incidence rate ratio of respiratory depression episodes in patients on supplemental oxygen, compared with breathing room air, as a function of PRODIGY score. Analysis includes full dataset (N = 202)
Fig. 3
Fig. 3
Percentage of patients with A ≥ 1 respiratory depression episode and B ≥ 1 apnea episode as a function of the length of time after surgery. The percent of patients is a population average and does not account for times when continuous monitoring transiently paused
See this image and copyright information in PMC

References

    1. Khanna AK, Bergese SD, Jungquist CR, Morimatsu H, Uezono S, Lee S, et al. Prediction of opioid-induced respiratory depression on inpatient wards using continuous capnography and oximetry: an international prospective. Observ Trial Anesth Analg. 2020;131(4):1012–1024. doi: 10.1213/ANE.0000000000004788. - DOI - PMC - PubMed
    1. Sun Z, Sessler DI, Dalton JE, Devereaux PJ, Shahinyan A, Naylor AJ, et al. Postoperative hypoxemia is common and persistent: a prospective blinded observational study. Anesth Analg. 2015;121(3):709–715. doi: 10.1213/ANE.0000000000000836. - DOI - PMC - PubMed
    1. Ramachandran SK, Thompson A, Pandit JJ, Devine S, Shanks AM. Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization. PLoS ONE. 2017;12(5):e0175408. doi: 10.1371/journal.pone.0175408. - DOI - PMC - PubMed
    1. Catley DM, Thornton C, Jordan C, Lehane JR, Royston D, Jones JG. Pronounced, episodic oxygen desaturation in the postoperative period: its association with ventilatory pattern and analgesic regimen. Anesthesiology. 1985;63(1):20–28. doi: 10.1097/00000542-198507000-00004. - DOI - PubMed
    1. Dempsey TM, Lapinsky SC, Melnychuk E, Lapinsky SE, Reed MJ, Niven AS. Special populations: disaster care considerations in chronically Ill, pregnant, and morbidly obese patients. Crit Care Clin. 2019;35(4):677–695. doi: 10.1016/j.ccc.2019.06.010. - DOI - PubMed

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