The waveform itself can also be used as a diagnostic tool with minimum training.
A numerical value and graph are displayed (Figure 1). In addition to mainstream sampling, which detects carbon dioxide levels at the endotracheal tube, side stream sampling via a cannula-like device can be used for both intubated and non-intubated patients. With the evolution of technology, noninvasive measures of end-tidal carbon dioxide are now available in the perioperative setting. Pulse oximetry and capnography waveforms. This argument to monitor all patients postoperatively is further strengthened when one considers all the risk factors for postoperative pulmonary complications that are not related to opioid administration. 4,5 In fact, so many risk factors have been identified that many experts believe that all patients receiving opioids postoperatively should be monitored for respiratory depression. Numerous risk factors for postoperative opioid-induced respiratory depression have been identified including older age, very young age, obesity, obstructive sleep apnea, neurologic disease, cardiovascular disease, and others. Respiratory failure was defined as “mechanical ventilation for more than 48 hours after surgery or the need for reintubation after postoperative extubation.” 4 Examples of such risk factors are hypoalbuminemia, advanced age (>70 years old), renal insufficiency, type of surgery (i.e., AAA, thoracic), emergency surgery, general anesthesia, COPD, and dependency status. found that 3.4% of patients undergoing noncardiac surgery suffered postoperative pulmonary failure. In a greater than 80,000 subject study, Arozullah et al. Several independent risk factors for postoperative pulmonary failure have been identified. 3 It is thus evident that postoperative respiratory complications have significant and widespread sequelae for both the patient and the health care system.
1 It is widely believed that the induction and maintenance of anesthesia may be a contributing factor to the development of postoperative pulmonary complications due to the “disruption of the normal activity of the respiratory muscles,” 2 ultimately leading to atelectasis and hypoxia.Īccording to Zhan et al., postoperative respiratory failure (not including pulmonary embolism) added approximately 9 hospital days to hospital length of stay, greater than $53,000 to hospital costs, and an almost 22% increase in mortality. Some studies have found that up to 14.2% of all surgical patients experience postoperative pulmonary complications, particularly those with open upper abdominal procedures. Such complications can be attributed to the type of surgery, anesthesia, and/or patient risk factors. Without intervention, respiratory compromise can lead to a variety of complications including pneumonia, reintubation and respiratory arrest. Respiratory compromise following surgery and/or sedation is an umbrella definition that encompasses causes of both hypoxia and hypoventilation. As perioperative physicians, we are largely concerned with postoperative respiratory compromise because of its impact on morbidity and mortality, as well as on healthcare costs.
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