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Continuous Capnography Reduces the Incidence of Opioid-Induced Respiratory Rescue by Hospital Rapid Resuscitation Team

Stites, Mindy*; Surprise, Jennifer*; McNiel, Jennifer; Northrop, David; De Ruyter, Martin§

doi: 10.1097/PTS.0000000000000408
Original Article: PDF Only

Objective The aim of this study was to determine the impact of end tidal carbon dioxide or capnography monitoring in patients requiring patient-controlled analgesia (PCA) on the incidence of opioid-induced respiratory depression (OIRD) in the setting of rapid response.

Methods A retrospective analysis was conducted in an urban tertiary care facility on the incidence of OIRD in the setting of rapid response as defined by a positive response to naloxone from January 2012 to December 2015. In March 2013, continuous capnography monitoring was implemented for all patients using PCA.

Results The preintervention incidence of OIRD in the setting of rapid response was 0.04% of patients receiving opioids. After the implementation of capnography, the incidence of OIRD in the setting of rapid response was reduced to 0.02%, which was statistically significant (χ2 = 46.246; df, 1; P < 0.0001). The rate of transfers to a higher level of care associated with these events was also reduced by 79% (baseline, 7.6 transfers/month; postintervention, 1.6 transfers/month).

Conclusions Continuous capnography monitoring in patients receiving PCA significantly reduces the incidence of OIRD in the setting of rapid response and unplanned transfers to a higher level of care.

From the Departments of *Nursing, †Quality & Safety, ‡Respiratory Therapy Services, The University of Kansas Hospital; and §Department of Anesthesiology, Kansas University Medical Center, Kansas City, Kansas.

Correspondence: Mindy Stites, MSN, APRN, ACCNS-AG, ACNS-BC, CCNS, CCRN, Department of Nursing, The University of Kansas Hospital, 3901 Rainbow Blvd, Mailstop 2018, Kansas City, KS 66160 (e-mail:

The authors disclose no conflict of interest.

No funding was received for authorship of this article.

Jennifer Surprise has participated in the Medical Advisory Boards for Medtronic and Hospira.

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