Impact of a continuous enhanced cardio-respiratory monitoring pathway on cardio-respiratory complications after bariatric surgery: A retrospective cohort study

Tian, Chenchen; Hawryluck, Laura; Tomlinson, George; Chung, Frances; Beattie, Scott; Miller, Matthew; Hassan, Najia; Wong, David T.; Wong, Jean; Hudson, John W.; Jackson, Timothy; Singh, Mandeep

doi:10.1016/j.jclinane.2021.110639

Cited by 9 publications

(5 citation statements)

References 38 publications

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“…38 Multiple subsequent studies investigating a variety of continuous monitoring modalities have also found decreases in RRTs and ICU transfers, and in 1 study decreases in cardiac arrests and in-hospital mortality were also noted. 39–44 Meta-analyses have shown similar results, including reductions in ICU transfers but not in mortality. 45,46 However, most of these studies lacked detailed information about the larger rescue system infrastructure and about how monitoring is operationalized and built into clinical workflows.…”

Section: Pro Position: Universal Continuous Respiratory Monitoring Of...mentioning

confidence: 82%

“…113,114 An enhanced monitoring pathway has been described for bariatric surgery that can monitor continuous pulse oximetry, heart rate, and respiratory rate and that can detect respiratory failure from reduced oxygen status. 44 The wireless unit communicated with the surveillance system (in this case Masimo Patient SafetyNet) and notified bedside clinicians when changes occurred, which subsequently led to a lower incidence of cardiorespiratory events and shorter length of stay. This level of monitoring was associated with fewer adverse postoperative events in this high-risk group of patients undergoing bariatric surgery.…”

Section: Postoperative Monitoring Optionsmentioning

confidence: 99%

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Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

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McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

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In this Pro-Con commentary article, we discuss use of continuous physiologic monitoring for clinical deterioration, specifically respiratory depression in the postoperative population. The Pro position advocates for 24/7 continuous surveillance monitoring of all patients starting in the postanesthesia care unit until discharge from the hospital. The strongest arguments for universal monitoring relate to inadequate assessment and algorithms for patient risk. We argue that the need for hospitalization in and of itself is a sufficient predictor of an individual’s risk for unexpected respiratory deterioration. In addition, general care units carry the added risk that even the most severe respiratory events will not be recognized in a timely fashion, largely due to higher patient to nurse staffing ratios and limited intermittent vital signs assessments (e.g., every 4 hours). Continuous monitoring configured properly using a “surveillance model” can adequately detect patients' respiratory deterioration while minimizing alarm fatigue and the costs of the surveillance systems. The Con position advocates for a mixed approach of time-limited continuous pulse oximetry monitoring for all patients receiving opioids, with additional remote pulse oximetry monitoring for patients identified as having a high risk of respiratory depression. Alarm fatigue, clinical resource limitations, and cost are the strongest arguments for selective monitoring, which is a more targeted approach. The proponents of the con position acknowledge that postoperative respiratory monitoring is certainly indicated for all patients, but not all patients need the same level of monitoring. The analysis and discussion of each point of view describes who, when, where, and how continuous monitoring should be implemented. Consideration of various system-level factors are addressed, including clinical resource availability, alarm design, system costs, patient and staff acceptance, risk-assessment algorithms, and respiratory event detection. Literature is reviewed, findings are described, and recommendations for design of monitoring systems and implementation of monitoring are described for the pro and con positions.

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Section: Pro Position: Universal Continuous Respiratory Monitoring Of...mentioning

confidence: 82%

Section: Postoperative Monitoring Optionsmentioning

confidence: 99%

Pro-Con Debate: Universal Versus Selective Continuous Monitoring of Postoperative Patients

Blike,

McGrath,

Ochs Kinney

et al. 2024

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

show abstract

“…These findings are consistent with the results of at least seven large (>1000 patients) studies reporting significant postoperative clinical outcome benefits after the implementation of continuous monitoring on hospital wards. 17 , 18 , 19 , 20 , 21 , 22 , 23 Five of these studies 17 , 19 , 21 , 22 , 23 reported a significant decrease in the number of RRT interventions after the implementation of continuous monitoring of heart rate, respiratory rate, blood pressure, and/or oxygenation saturation on regular wards. Two studies 17 , 23 reported a significant decrease in the number of ICU transfers.…”

Section: Discussionmentioning

confidence: 99%

“… 17 , 18 , 19 , 20 , 21 , 22 , 23 Five of these studies 17 , 19 , 21 , 22 , 23 reported a significant decrease in the number of RRT interventions after the implementation of continuous monitoring of heart rate, respiratory rate, blood pressure, and/or oxygenation saturation on regular wards. Two studies 17 , 23 reported a significant decrease in the number of ICU transfers. In one study, 20 the continuous monitoring of heart rate, oxygen saturation, and respiratory rate in 2263 ward patients was associated with a significant decrease in the number of cardiac arrests and in hospital mortality.…”

Section: Discussionmentioning

confidence: 99%