The Respiratory Compromise Institute (RCI) has published a report titled “Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients.” The RCI Report is published by the American Association for Respiratory Care (AARC), and addresses the unmet needs of respiratory compromise from a clinical practice perspective.
The Institute was formalized by the National Association for Medical Direction of Respiratory Care (NAMDRC) to define respiratory compromise and develop educational and research opportunities to help clinicians address respiratory compromise in clinical and home settings. NAMDRC works closely with the Physician Patient Alliance for Health & Safety to develop many of RCI’s communications.
The report notes that respiratory compromise is one of the most serious contributing factors to in-hospital patient mortality among common conditions. The team found that the development of in-hospital respiratory failure is associated with mortality rates of nearly 40%—a rate of death “twice as high as myocardial infarction and several times higher than for cancer, stroke, congestive heart failure, and renal failure.”
The report identifies eight subsets of respiratory compromise that pose a high risk of patient harm, but could be prevented with early detection and intervention. It also recommends detection strategies for these subsets, and suggests that there is an opportunity to update the triggers for rapid response teams to directly address these specific patient populations.
The report recommends two key monitoring strategies for patients at risk of respiratory compromise due to impaired control of breathing as a key risk category. This subset is defined as those undergoing procedural/postoperative sedation, sleep apnea, and opioids or respiratory suppressant drugs:
- Continuous and accurate measurement of gas exchange. The report notes that monitoring of blood oxygenation (typical with pulse oximetry) is fairly routine; however, other monitoring options such as end-tidal capnography, blood pressure, electrocardiogram, and transcutaneous PCO2 may detect respiratory compromise earlier.
- Clinical scales for risk assessment. The report suggests the use of clinical scales to measure consciousness, delirium, pain, and sleep apnea risk in patients. The STOPBang tool, Risk Index for Serious Opioid-Induced Respiratory Depression (RIOSORD), and the PCA Safety Checklist are all tools and clinical scales that have been highlighted by PPAHS in the past.
The team highlights that neither intermittent spot checks nor continuous electronic monitoring are sufficient in isolation to detect rapid respiratory depression, instead suggesting that a combination of the two be employed to effectively save patients.