Respiratory Compromise Toolkit

 

What is Respiratory Compromise?

Respiratory compromise is a deterioration in respiratory status with the potential for progression into respiratory failure or death in which timely specific interventions such as enhanced monitoring or therapies may prevent or lessen decompensation. Respiratory Compromise occurs in a range of practice settings and care contexts. Early identification of respiratory compromise is the key to instituting appropriate interventions to avoid catastrophic events.1

The concept of respiratory compromise is not new the respiratory therapy or to health care. However, there is a need for ongoing research so that the exact scope, range of etiologies, incidence and severity can be better understood. 2

There exists a growing body of literature on respiratory compromise in certain patient care contexts. The CSRT has opted to focus on two priority areas based on the evidence in the literature: procedural sedation and post-operative respiratory deterioration.

1Morris, TA, Gay, PC, MacIntyre, NR., Hess, DR, Hanneman, SK, Lamberti, JP,  Doherty, DE, Chang, L, and Seckel, MA. (2017). Respiratory compromise as a new paradigm for the care of vulnerable hospitalized patients. Respir Care 62 (4) 497-512; DOI: https://doi.org/10.4187/respcare.05021 http://rc.rcjournal.com/content/62/4/497.short

2Correia, R, Wnuk, A., Zaccagnini, M., West, A. (2019). Actioning our understanding of respiratory compromise Can J Respir Ther 55:28-29. https://www.cjrt.ca/wp-content/uploads/doi-10.29390cjrt-2018-026.pdf

 

Click on the various shapes for more information.

Click on the various shapes for more information.
Institutional Factors Patient Factors Caregiver Factors Procedural Factors Procedural Sedation Respiratory Compromise Post-Op Deterioration

Institutional Factors

Institutional risk factors for respiratory compromise include underfunding, a distant location of monitoring stations or equipment relative to staff and patients, various environmental factors (noise, lighting, temperature) and a lack of protocols relating to medication administration and patient monitoring.

References

Association for the Advancement of Medical Instrumentation. (2010). Infusing patients safely: priority issues from the AAHI/FDA infusion device summit. Arlington: AAMI.

Canadian Medical Protective Association. (2016, September). Safe use of opioid analgesics in the hospital setting. Retrieved from Canadian Medical Protective Association: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2016/safe-use-of-opioid-analgesics-in-the-hospital-setting

Lynn, L. A., & Curry , J. P. (2011). Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Safety in Surgery, 5(3).

Patient Factors

Patient-related factors that elevate the risk of respiratory compromise include the patient’s age (with the very young and the elderly at highest risk), history of cigarette/alcohol use and the need for medications that suppress the drive to breathe (e.g. opioids). Patients who require airway protection or intubation and those who do not understand their course of treatment (procedures, medications, risks, etc.) are also at elevated risk for respiratory compromise. The following comorbidities are also associated with an increased risk: cardiovascular, lung, liver, kidney or neuromuscular disease; cancer, diabetes, obesity, sepsis, organ dysfunction/failure; CNS injury or disease; chest cage dysfunction; sleep disordered breathing.

References
Alvarez, M. P., Samayoa-Mendez, A. X., Naglak, M. C., Yuschak, J. V., & Murayama , K. M. (2015). Risk factors for postoperative unplanned intubation: analysis of a national database. The American Surgeon, 81(8), 820-825.

Morris, T. A., Gay, P. C., MacIntyre, N. R., Hess, D. R., Hanneman, S. K., Lamberti, J. P., . . . Seckel, M. A. (2017). Respiratory compromise as a new paradigm for the care of vulnerable hospitalized patients. Respiratory Care, 62(4), 497-512.

Ramchandran, S. K., Nafiu, O. O., Tremper, K. K., Shanks, A., & Kheterpal, S. (2011). Independent predictors and outcomes of unanticipated ealry postoperative tracheal intubation after nonemergent, noncardiac surgery. Anesthesiology, 115(1), 44-53.

Weingarten, T. N., Herasevich, V., McGlinch, M. C., Beatty, N. C., Christensen, E. D., Hannifan , S. K., et al. (2015). Predictors of delayed postoperative respiratory depression assessed from naloxone administration. Anesthesia and Analgesia, 121(2).

Caregiver Factors

Caregiver risk factors for respiratory compromise include communication barriers within the healthcare team, alarm fatigue, improper/insufficient education or training, medication errors and caregiver fatigue/illness.

References
Association for the Advancement of Medical Instrumentation. (2010). Infusing patients safely: priority issues from the AAHI/FDA infusion device summit. Arlington: AAMI.

Canadian Medical Protective Association. (2016, September). Safe use of opioid analgesics in the hospital setting. Retrieved from Canadian Medical Protective Association: https://www.cmpa-acpm.ca/en/advice-publications/browse-articles/2016/safe-use-of-opioid-analgesics-in-the-hospital-setting

Lynn, L. A., & Curry , J. P. (2011). Patterns of unexpected in-hospital deaths: a root cause analysis. Patient Safety in Surgery, 5(3).

Procedural Factors

Patients who have recently undergone a long or complicated procedure requiring anesthesia, sedation or pain-relieving medications or patients who required a blood transfusion during surgery are at increased risk of respiratory compromise.

References:
Alvarez, M. P., Samayoa-Mendez, A. X., Naglak, M. C., Yuschak, J. V., & Murayama , K. M. (2015). Risk factors for postoperative unplanned intubation: analysis of a national database. The American Surgeon, 81(8), 820-825.

Weingarten, T. N., Herasevich, V., McGlinch, M. C., Beatty, N. C., Christensen, E. D., Hannifan , S. K., et al. (2015). Predictors of delayed postoperative respiratory depression assessed from naloxone administration. Anesthesia and Analgesia, 121(2).

Procedural Sedation

Respiratory Compromise

Post-Op Deterioration

 

Respiratory Compromise

 

Priority area 1:Procedural Sedation

 

Priority area 2: Post-Operative Deterioration