Postoperative Oxygen Therapy in Patients With OSA

Liao, Pu; Wong, Jean; Singh, Mandeep; Wong, David T.; Islam, Sazzadul; Andrawes, Maged; Shapiro, Colin M.; White, David P.; Chung, Frances

doi:10.1016/j.chest.2016.12.005

Cited by 59 publications

(55 citation statements)

References 46 publications

(51 reference statements)

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“…It is now well established that oxygen therapy in the postoperative period significantly reduces abnormal desaturation episodes seen with sleep disordered breathing. [41] This finding may partially explain the lack of relationship between desaturation measures and STOP-Bang scores or opioid type in other studies. [42,43] The association of oxygen therapy with increased resource utilization and PRC suggests that such treatment improves oxygenation but does not alter the underlying risk of the patient for adverse outcome.…”

Section: Discussionmentioning

confidence: 94%

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

et al. 2017

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IntroductionThe clinical importance of postoperative episodic hypoxemia is still unclear, and therefore largely under-studied. As a result, there is limited understanding of its relationship with early postoperative respiratory complications (PRC, defined as intubation within three days of surgery) and hospital resource utilization.Materials and methodsThis single center study was performed using a retrospective observational design. We described population based definitions of desaturation from continuous SpO2 monitoring data captured in the post anesthesia care unit (PACU), namely median SpO2 in PACU, duration of desaturation below median, nadir desaturation, and length of oxygen therapy relative to PACU duration. These measures were evaluated against the occurrence of early PRC in logistic regression models. Measures that were independently associated with early PRC were accepted as the primary study exposures. Stratified logistic regression models were planned if significant interaction occurred with high risk surgical procedures. Models were adjusted by including several patient conditions, procedural, and anesthesia risk factors. Propensity matching on desaturation occurrence was planned to evaluate the relationship with postoperative resource utilization.ResultsAmong 125,740 patients included in the univariate analyses, 351 patients (0.3%) developed early PRC. Nadir desaturation <89% [14.3% of patients; adjusted odds ratio 2.02; 95% CI 1.52, 2.68; p<0.001] and PACU oxygen therapy requirements greater than 60 min [adjusted odds ratio 1.92 (>60 min) to 3.04 (>90 min); p<0.001] were identified as independent predictors of early PRC occurrence. A modest interaction was observed between desaturation and higher surgical risk. Propensity matching for postoperative oxygen requirement was performed in 37,354 matched patients. Matched analysis demonstrated significant increase in day of surgery charges, respiratory charges, total charges, hospital length of stay, reintubation and use of invasive or non-invasive ventilatory support.ConclusionsIn summary, we report that prolonged PACU oxygen therapy and nadir desaturation <89% in PACU as captured in a retrospective database are independently associated with early PRC. This study describes resource implications of PACU desaturation in a large academic medical center in North America.

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Section: Discussionmentioning

confidence: 94%

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

et al. 2017

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“…Among patients with OSA, continuous supplemental oxygen is recommended as an adjuvant to effective CPAP to manage early postoperative hypoxaemia (Spo 2 < 92%), resulting in improvements in oxygenation and a reduction in AHI . Supplemental oxygen therapy should be continued until the patient's baseline preoperative oxygen saturations are achieved while breathing room air .…”

Section: Postoperative Adjuvant Strategiesmentioning

confidence: 99%

Perioperative considerations in the management of obstructive sleep apnoea

Holt

Downey

Naughton

2019

Medical Journal of Australia

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Obstructive sleep apnoea (OSA) is characterised by repetitive compromise of the upper airway, causing impaired ventilation, sleep fragmentation, and daytime functional impairment. It is a heterogeneous condition encompassing different phenotypes. 1 Risk factors, pathogenic mechanisms, and treatment for obstructive sleep apnoea 12 CPAP = continuous positive airway pressure; HGNS = hypoglossal nerve stimulation; MAD = mandibular advancement device. Source: figure reproduced, with permission, from Jordan et al. 12 ◆

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“…While pulse oximetry for oxygenation monitoring is part of standard monitoring in the PACU, hypoventilation cannot reliably be detected by pulse oximetry when patients are on supplemental oxygen [15][16][17]. Combined with pulse oximetry, capnography, which measures end-tidal CO 2 (EtCO 2 , also called PetCO 2 ), pulse rate (PR), and respiration rate (RR), can provide a more complete characterization of pulmonary function.…”

Section: Introductionmentioning

confidence: 99%

Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial

Chung

Wong

Mestek

et al. 2019

J Clin Monit Comput

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The utility of capnography to detect early respiratory compromise in surgical patients after anesthesia is unclear due to limited prospective data. The purpose of this trial was to determine the frequency and duration of capnography-detected respiratory adverse events in the post-anesthesia care unit (PACU). In this prospective observational trial, 250 consenting patients undergoing elective surgery with general anesthesia were monitored by standard monitoring together with blinded capnography and pulse oximetry monitoring. The capnography notification settings were adjusted to match nursing (Level II) and physician (Level I) alarm thresholds. 163 (95%) patients had a Level II notification and 135 (78%) had a Level I notification during standard monitoring. The most common events detected by the capnography monitor included hypocapnia, apnea, tachypnea, bradypnea and hypoxemia, with silent notification duration for these events ranging from 17 ± 13 to 189 ± 127 s. During standard monitoring, 15 respiratory adverse events were reported, with 8 events occurring when valid blinded/silenced capnography and pulse oximetry data was collected simultaneously. Capnography and the Integrated Pulmonary Index™ algorithm (IPI) detected respiratory adverse events earlier than standard monitoring in 75% and 88% of cases, respectively, with an average early warning time of 8 ± 11 min. Three patients' blinded capnography was unblinded to facilitate clinical care. Respiratory adverse events are frequent in the PACU, and the addition of capnography and IPI to current standard monitoring provides potentially clinically relevant information on respiratory status, including early warning of some respiratory adverse events. Trial registration ClinialTrials.gov Identifier NCT02707003 (https ://clini caltr ials.gov/ct2/show/NCT02 70700 3).

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Postoperative Oxygen Therapy in Patients With OSA

Abstract: ClinicalTrials.gov; No.: NCT01552304; URL: www.clinicaltrials.gov.

Cited by 59 publications

References 46 publications

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

Retrospective observational evaluation of postoperative oxygen saturation levels and associated postoperative respiratory complications and hospital resource utilization

Perioperative considerations in the management of obstructive sleep apnoea

Characterization of respiratory compromise and the potential clinical utility of capnography in the post-anesthesia care unit: a blinded observational trial

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