Capnography, Patient Monitoring

Open Letter for Patient Safety and Use of Continuous Electronic Monitoring

In the story, “Hypoxia After Surgery Much More Common Than Previously Believed — Study finds high rate of prolonged bouts of desaturation on wards” (Anesthesiology News, March), Daniel Sessler, MD (Michael Cudahy Professor & Chair, Department of Outcomes Research, The Cleveland Clinic; Director, Outcomes Research Consortium) who helped conduct the study, described its results as “sobering.”

This research found that a large fraction of patients experiences prolonged periods of hypoxemia while recovering from surgery – approximately 21 percent of patients averaged at least 10 minutes per hour with SpO2 values below 90 percent, approximately 8 percent of patients averaged at least 20 minutes per hour, and approximately 8 percent of patients averaged at least 5 minutes per hour with SpO2 less than 85 percent. As Dr. Sessler noted, most health experts agree that long periods of oxygen desaturation are not good for patients. Dr. Sessler also pointed out that physicians need an early warning sign for respiratory distress, which is currently only possible through continuous electronic monitoring.

We couldn’t agree more with his description. A recent research report from HealthGrades confirms the seriousness of these findings. HealthGrades examined nearly 288,000 life-threatening events that occurred among Medicare patients in U.S. hospitals from 2009 through 2011. According to HealthGrades, three patient safety-indicators accounted for two-thirds (66.7 percent) of these adverse events: respiratory failure after surgery; deep blood clots in the lungs or legs following surgery; and accidental punctures or lacerations during a procedure. A more relevant fact was that respiratory failure represented 60,632 (22 percent) of the 287,630 adverse events listed in the HealthGrades report.

Dr. Sessler states that because hypoxia is so common, he believes continuous pulse oximetry will become a standard of care in the next five to 10 years. However, five to 10 years is too long to wait, according to the Anesthesia Patient Safety Foundation (APSF).

Referring to a recent released video by the APSF, Robert Steolting, MD (President, APSF) believes that there must be a paradigm shift in the way that we monitor receiving opioids. As he says:

“It’s time for a change in how we monitor postoperative patients receiving opioids. We need a complete paradigm shift in how we approach safer care for postoperative patients receiving opioids.”

Continuous electronic monitoring of all patients receiving opioids with pulse oximetry for oxygenation and capnography for adequacy of ventilation, as recommended by the APSF, would be the “alert” that we need to intervene in a timely manner for better patient safety and outcomes.

Although we fervently concur that continuous electronic monitoring needs to be a national patient-safety standard, we sincerely hope this occurs far sooner than Dr. Sessler predicts. Why? Because patients’ lives are literally at stake. We can’t afford to wait any longer. Having lost our otherwise healthy loved ones — Amanda, John, and Leah — to undetected respiratory depression, we know this all too well.

Sincerely,

Cindy and Brian Abbieh (Founders, A Promise to Amanda Foundation)

Patricia LaChance (Wife of John Michael LaChance)

Lenore Alexander (Founder & Executive Director, LeahsLegacy)

Michael Wong, JD (Founder & Executive Director, Physician-Patient Alliance for Health & Safety) – for all patients – and their families – who have suffered an adverse event or death due to undetected respiratory depression

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