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Doufas AG, Laporta ML, Driver CN, Di Piazza F, Scardapane M, Bergese SD, Urman RD, Khanna AK, Weingarten TN. Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial. BMC Anesthesiol 2023; 23:332. [PMID: 37794334 PMCID: PMC10548743 DOI: 10.1186/s12871-023-02291-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 09/22/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Supplemental oxygen (SO) potentiates opioid-induced respiratory depression (OIRD) in experiments on healthy volunteers. Our objective was to examine the relationship between SO and OIRD in patients on surgical units. METHODS This post-hoc analysis utilized a portion of the observational PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial dataset (202 patients, two trial sites), which involved blinded continuous pulse oximetry and capnography monitoring of postsurgical patients on surgical units. OIRD incidence was determined for patients receiving room air (RA), intermittent SO, or continuous SO. Generalized estimating equation (GEE) models, with a Poisson distribution, a log-link function and time of exposure as offset, were used to compare the incidence of OIRD when patients were receiving SO vs RA. RESULTS Within the analysis cohort, 74 patients were always on RA, 88 on intermittent and 40 on continuous SO. Compared with when on RA, when receiving SO patients had a higher risk for all OIRD episodes (incidence rate ratio [IRR] 2.7, 95% confidence interval [CI] 1.4-5.1), apnea episodes (IRR 2.8, 95% CI 1.5-5.2), and bradypnea episodes (IRR 3.0, 95% CI 1.2-7.9). Patients with high or intermediate PRODIGY scores had higher IRRs of OIRD episodes when receiving SO, compared with RA (IRR 4.5, 95% CI 2.2-9.6 and IRR 2.3, 95% CI 1.1-4.9, for high and intermediate scores, respectively). CONCLUSIONS Despite oxygen desaturation events not differing between SO and RA, SO may clinically promote OIRD. Clinicians should be aware that postoperative patients receiving SO therapy remain at increased risk for apnea and bradypnea. TRIAL REGISTRATION Clinicaltrials.gov: NCT02811302, registered June 23, 2016.
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Affiliation(s)
- Anthony G Doufas
- Department of Anesthesiology, Perioperative and Pain Medicine, Center for Sleep and Circadian Sciences, Stanford University School of Medicine, 300 Pasteur Drive, H3580, Stanford, San Francisco, CA, 94305-5640, USA.
| | - Mariana L Laporta
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - C Noelle Driver
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy
| | - Marco Scardapane
- Medtronic Core Clinical Solutions, Global Clinical Data Solutions, Rome, Italy
| | - Sergio D Bergese
- Department of Anesthesiology and Neurological Surgery, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - Richard D Urman
- Department of Anesthesiology, The Ohio State University and Wexner Medical Center, Columbus, OH, USA
| | - Ashish K Khanna
- Section On Critical Care Medicine, Department of Anesthesiology, Wake Forest Center for Biomedical Informatics, Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Outcomes Research Consortium, Cleveland, OH, USA
| | - Toby N Weingarten
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
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Liew LQN, Law LSC, Seet E, Di Piazza F, Liu KE, Sim MA, Chua VTY, Weingarten TN, Khanna AK, Ti LK. Nocturnal Oxygen Desaturation Index Correlates with Respiratory Depression in Post-Surgical Patients Receiving Opioids - A Post-Hoc Analysis from the Prediction of Opioid-Induced Respiratory Depression in Patients Monitored by Capnography (PRODIGY) Study. Nat Sci Sleep 2022; 14:805-817. [PMID: 35510128 PMCID: PMC9058859 DOI: 10.2147/nss.s351840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Postoperative monitoring of respiratory status on general care wards typically consists of intermittent checks of oxyhemoglobin saturation and respiratory rate, allowing substantial unmonitored time for severe opioid induced respiratory depression (RD) to develop unnoticed. Oxygen desaturation index (ODI) can be computed solely by continuous pulse oximetry monitoring. In this post-hoc analysis, we evaluate whether nocturnal ODI correlates with RD. Patients and Methods The PRODIGY trial (NCT02811302) was a multinational study conducted where adult patients receiving parenteral opioids on the general care floor were continuously monitored by blinded pulse oximetry and capnography monitoring to detect episodes of RD. An RD episode was defined as: respiratory rate ≤5 breaths/min (bpm) for ≥3 minutes, oxygen saturation (SpO2) ≤85% for ≥3 minutes, end-tidal carbon dioxide (EtCO2) ≤15 or ≥60 mm Hg for ≥3 minutes, apnea episode lasting >30 seconds, or any respiratory opioid-related adverse event. Data were used to calculate nocturnal (00:00 ─ 06:00) ODI4% based on desaturation episodes (4% decrease from mean oxyhemoglobin saturation in the past 120 seconds, lasting ≥10 seconds). Continuous monitoring began after a patient received parenteral opioids, allowing identification of potential RD and ODI4% episodes during opioid therapy. The average number of ODI4% episodes (≥1, ≥5, ≥10, ≥15 episodes/hour) were analyzed. Logistic regression and area under the receiver operating characteristic curve (AUC) were computed. Results A final cohort of 1072 (out of 1335) patients had sufficient data, with 76% (N=817/1072) having ≥1 episode of ODI4%. Multivariable logistic regression showed that ODI4% was strongly associated with RD, with greater risk for higher ODI4% scores: ≥5 episodes/hour odds ratio 2.59 (95% CI 1.72-3.89, p<0.0001); ≥10 episodes/hour 3.39 (95% CI 1.80-6.39, p=0.0002); ≥15 episodes/hour 4.71 (95% CI 1.93-11.47, p=0.0006).There was no significant association between ODI4% and respiratory adverse events. Conclusion Nocturnal ODI4% was highly correlated with RD among hospitalized patients receiving parenteral opioids. Patients with a high ODI4%, especially with ≥15 episodes/hour, are more likely to experience RD and should be evaluated for the need of closer monitoring after opioid administration.
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Affiliation(s)
| | | | - Edwin Seet
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
| | - Katherine E Liu
- Patient Monitoring Clinical Research, Medtronic, Minneapolis, MN, USA
| | - Ming Ann Sim
- National University Hospital, Singapore, Singapore
| | | | - Toby N Weingarten
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ashish K Khanna
- Wake Forest School of Medicine, Winston-Salem, North Carolina, US & Outcomes Research Consortium, Cleveland, OH, USA
| | - Lian Kah Ti
- National University Hospital, Singapore, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
| | - On behalf of the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators
- National University Hospital, Singapore, Singapore
- National University of Singapore, Yong Loo Lin School of Medicine, Singapore
- Medtronic Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
- Patient Monitoring Clinical Research, Medtronic, Minneapolis, MN, USA
- Departments of Anesthesiology and Perioperative Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Wake Forest School of Medicine, Winston-Salem, North Carolina, US & Outcomes Research Consortium, Cleveland, OH, USA
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Pavlovic N, Chierchia GB, Velagic V, Hermida JS, Healey S, Arena G, Badenco N, Meyer C, Chen J, Iacopino S, Anselme F, Dekker L, Scazzuso F, Packer DL, de Asmundis C, Pitschner HF, Piazza FD, Kaplon RE, Kuniss M. Initial rhythm control with cryoballoon ablation vs drug therapy: Impact on quality of life and symptoms. Am Heart J 2021; 242:103-114. [PMID: 34508694 DOI: 10.1016/j.ahj.2021.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) as a first-line rhythm control strategy is superior to antiarrhythmic drugs (AADs) for preventing atrial fibrillation (AF) recurrence; the impact of first-line CBA on quality of life (QoL) and symptoms has not been well characterized. METHODS Patients aged 18 to 75 with symptomatic paroxysmal AF naïve to rhythm control therapy were randomized (1:1) to CBA (Arctic Front Advance, Medtronic) or AAD (Class I or III). Symptoms and QoL were assessed at baseline, 1, 3, 6, 9, and 12 months using the EHRA classification and Atrial Fibrillation Effect on QualiTy-of-Life (AFEQT) and SF-36v2 questionnaires. Symptomatic palpitations were evaluated via patient diary. RESULTS Overall, 107 patients were randomized to CBA and 111 to AAD; crossovers occurred in 9%. Larger improvements in the AFEQT summary, subscale and treatment satisfaction scores were observed at 12 months with CBA vs AAD (all P <0.05). At 12 months, the mean adjusted difference in the AFEQT summary score was 9.9 points higher in the CBA group (95% CI: 5.5 -14.2, P <0.001). Clinically important improvements in the SF-36 physical and mental component scores were observed at 12 months in both groups, with no significant between group differences at this timepoint. In the CBA vs AAD group, larger improvements in EHRA class were observed at 6, 9 and 12 months (P <0.05) and the incidence rate of symptomatic palpitations was lower (4.6 vs 15.2 days/year post-blanking; IRR: 0.30, P <0.001). CONCLUSIONS In patients with symptomatic AF, first-line CBA was superior to AAD for improving AF-specific QoL and symptoms. TRIAL REGISTRATION ClinicalTrials.gov number: NCT01803438.
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Kuniss M, Pavlovic N, Velagic V, Hermida JS, Healey S, Arena G, Badenco N, Meyer C, Chen J, Iacopino S, Anselme F, Packer DL, Pitschner HF, Asmundis CD, Willems S, Di Piazza F, Becker D, Chierchia GB. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace 2021; 23:1033-1041. [PMID: 33728429 PMCID: PMC8286851 DOI: 10.1093/europace/euab029] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/25/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS Treatment guidelines for patients with atrial fibrillation (AF) suggest that patients should be managed with an antiarrhythmic drug (AAD) before undergoing catheter ablation (CA). This study evaluated whether pulmonary vein isolation employing cryoballoon CA is superior to AAD therapy for the prevention of atrial arrhythmia (AA) recurrence in rhythm control naive patients with paroxysmal AF (PAF). METHODS AND RESULTS A total of 218 treatment naive patients with symptomatic PAF were randomized (1 : 1) to cryoballoon CA (Arctic Front Advance, Medtronic) or AAD (Class I or III) and followed for 12 months. The primary endpoint was ≥1 episode of recurrent AA (AF, atrial flutter, or atrial tachycardia) >30 s after a prespecified 90-day blanking period. Secondary endpoints included the rate of serious adverse events (SAEs) and recurrence of symptomatic palpitations (evaluated via patient diaries). Freedom from AA was achieved in 82.2% of subjects in the cryoballoon arm and 67.6% of subjects in the AAD arm (HR = 0.48, P = 0.01). There were no group differences in the time-to-first (HR = 0.76, P = 0.28) or overall incidence [incidence rate ratio (IRR)=0.79, P = 0.28] of SAEs. The incidence rate of symptomatic palpitations was lower in the cryoballoon (7.61 days/year) compared with the AAD arm (18.96 days/year; IRR = 0.40, P < 0.001). CONCLUSIONS Cryoballoon CA was superior to AAD therapy, significantly reducing AA recurrence in treatment naive patients with PAF. Additionally, cryoballoon CA was associated with lower symptom recurrence and a similar rate of SAEs compared with AAD therapy.
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Affiliation(s)
- Malte Kuniss
- Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Nikola Pavlovic
- Sestre Milosrdnice University Hospital Centre, Zagreb, Croatia
| | | | | | | | | | - Nicolas Badenco
- AP-HP Sorbonne Université, ICAN Institute, Hopital Pitié-Salpétrière, Paris, France
| | - Christian Meyer
- University Heart Center, Hamburg, Cardiac Neuro- and Electrophysiology Research Consortium, EVK Düsseldorf, Düsseldorf, Germany
| | - Jian Chen
- Haukeland University Hospital, University of Bergen, Bergen, Norway
| | | | | | | | | | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stephan Willems
- University Heart Center, Hamburg, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Fabio Di Piazza
- Medtronic, Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
| | | | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
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Khanna AK, Jungquist CR, Buhre W, Soto R, Di Piazza F, Saager L, Bergese SD, Morimatsu H, Uezono S, Lee S, Ti LK, Urman RD, McIntyre R, Tornero C, Dahan A, Weingarten TN, Wittmann M, Auckley D, Brazzi L, Le Guen M, Schramm F, Overdyk FJ. Modeling the Cost Savings of Continuous Pulse Oximetry and Capnography Monitoring of United States General Care Floor Patients Receiving Opioids Based on the PRODIGY Trial. Adv Ther 2021; 38:3745-3759. [PMID: 34031858 PMCID: PMC8143066 DOI: 10.1007/s12325-021-01779-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/06/2021] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Despite the high incidence of respiratory depression on the general care floor and evidence that continuous monitoring improves patient outcomes, the cost-benefit of continuous pulse oximetry and capnography monitoring of general care floor patients remains unknown. This study modeled the cost and length of stay savings, investment break-even point, and likelihood of cost savings for continuous pulse oximetry and capnography monitoring of general care floor patients at risk for respiratory depression. METHODS A decision tree model was created to compare intermittent pulse oximetry versus continuous pulse oximetry and capnography monitoring. The model utilized costs and outcomes from the PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial, and was applied to a modeled cohort of 2447 patients receiving opioids per median-sized United States general care floor annually. RESULTS Continuous pulse oximetry and capnography monitoring of high-risk patients is projected to reduce annual hospital cost by $535,531 and cumulative patient length of stay by 103 days. A 1.5% reduction in respiratory depression would achieve a break-even investment point and justify the investment cost. The probability of cost saving is ≥ 80% if respiratory depression is decreased by ≥ 17%. Expansion of continuous monitoring to high- and intermediate-risk patients, or to all patients, is projected to reach a break-even point when respiratory depression is reduced by 2.5% and 3.5%, respectively, with a ≥ 80% probability of cost savings when respiratory depression decreases by ≥ 27% and ≥ 31%, respectively. CONCLUSION Compared to intermittent pulse oximetry, continuous pulse oximetry and capnography monitoring of general care floor patients receiving opioids has a high chance of being cost-effective. TRIAL REGISTRATION www.clinicaltrials.gov , Registration ID: NCT02811302.
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Driver CN, Laporta ML, Bergese SD, Urman RD, Di Piazza F, Overdyk FJ, Sprung J, Weingarten TN. Frequency and Temporal Distribution of Postoperative Respiratory Depressive Events. Anesth Analg 2021; 132:1206-1214. [PMID: 33857962 DOI: 10.1213/ane.0000000000005478] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The frequency and temporal distribution of postoperative respiratory depression (RD) events are not completely understood. This study determined the temporal distribution and frequency of RD episodes in postsurgical patients continuously monitored by bedside capnography and pulse oximetry. METHODS This was a post hoc study of a subset of postsurgical patients enrolled in The PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) trial from 2 sites in the United States. These patients had undergone continuous bedside monitoring on general care wards. These data were adjudicated for potential RD episodes. The number of RD episodes per patient and the time of each RD episode were determined. The first RD episode experienced by a patient was classified as an "initial" episode, and the initial and all subsequent RD episodes experienced by a patient were classified as "all" episodes. A PRODIGY risk score was calculated. RESULTS Data analyzed from 250 patients contained 2539 RD episodes in 155 (62.0%, 95% confidence interval, 55.7-68.0) patients with median 2 [0-8], range of 0-545 RD episodes per patient, with a PRODIGY risk score distribution of 100 (40.0%) low, 79 (31.6%) intermediate, 70 (28.0%) high (missing data from 1 patient). Median time to the initial RD episode was 8.8 [5.1-18.0] hours postoperatively. There was a peak occurrence of initial RD events between 14:00 and 20:00 on the day of surgery, and these were associated with a large number of subsequent events in the same timeframe. The peak time of all RD episodes occurred from 02:00 to 06:00. Patients with high PRODIGY risk scores had higher incidence and greater number of RD episodes per patient (P < .001, overall comparisons between groups for both incidence [χ2] and number of episodes [Kruskal-Wallis test]). CONCLUSIONS Continuous monitoring of surgical patients demonstrates that RD episodes are common, and risk increases with higher PRODIGY scores. In this patient cohort, the rate of initial RD episodes peaked in the afternoon to early evening, while peak rate of all RD episodes occurred in early morning. Further, among patients with RD episodes, the number of episodes increased with higher PRODIGY scores.
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Affiliation(s)
- C Noelle Driver
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mariana L Laporta
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sergio D Bergese
- Department of Anesthesiology and Neurological Surgery, Stony Brook University School of Medicine, Stony Brook, New York
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
| | | | - Juraj Sprung
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Toby N Weingarten
- From the Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
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Urman RD, Khanna AK, Bergese SD, Buhre W, Wittmann M, Le Guen M, Overdyk FJ, Di Piazza F, Saager L. Response to: Comment on: Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial. J Clin Anesth 2021; 71:110228. [PMID: 33713932 DOI: 10.1016/j.jclinane.2021.110228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Sergio D Bergese
- Department of Anesthesiology, and Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Wolfgang Buhre
- Department of Anesthesiology, University Medical Center, Maastricht, Netherlands
| | - Maria Wittmann
- Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany
| | - Morgan Le Guen
- Department of Anaesthesiology, Hôpital Foch, Suresnes, France
| | | | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
| | - Leif Saager
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University Medical Center Goettingen, Germany
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Urman RD, Khanna AK, Bergese SD, Buhre W, Wittmann M, Le Guen M, Overdyk FJ, Di Piazza F, Saager L. Postoperative opioid administration characteristics associated with opioid-induced respiratory depression: Results from the PRODIGY trial. J Clin Anesth 2021; 70:110167. [PMID: 33493688 DOI: 10.1016/j.jclinane.2021.110167] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/21/2020] [Accepted: 12/26/2020] [Indexed: 02/06/2023]
Abstract
STUDY OBJECTIVE Opioid administration for pain in general care floor patients remains common, and can lead to adverse outcomes, including respiratory compromise. The PRODIGY trial found that among ward patients receiving parenteral opioids, 46% experienced ≥1 respiratory depression episode. The objective of this analysis was to evaluate the geographic differences of opioid administration and examine the association between opioid administration characteristics and the occurrence of respiratory depression. DESIGN Prospective observational trial. SETTING 16 general care medical and surgical wards in Asia, Europe, and the United States. PATIENTS 1335 patients receiving parenteral opioids. INTERVENTIONS Blinded, alarm-silenced continuous capnography and pulse oximetry monitoring. MEASUREMENTS Opioid-induced respiratory depression, defined as respiratory rate ≤ 5 bpm, SpO2 ≤ 85%, or ETCO2 ≤ 15 or ≥ 60 mmHg for ≥3 min; apnea episode lasting >30 s; or any respiratory opioid-related adverse event. RESULTS Across all patients, 58% received only long-acting opioids, 16% received only short-acting (<3 h) opioids, and 21% received a combination of short- and long-acting (≥3 h) opioids. The type and median total morphine milligram equivalent (MME) of opioid administered varied significantly by region, with 31.5 (12.5-76.7) MME, 31.0 (6.2-99.0) MME, and 7.2 (1.7-18.7) MME in the United States, Europe, and Asia, respectively (p < 0.001). Considering only postoperative opioids, 54% (N = 119/220) and 45% (N = 347/779) of patients receiving only short-acting opioids or only long-acting opioids experienced ≥1 episode of opioid-induced respiratory depression, respectively. Multivariable analysis identified post-procedure tramadol (OR 0.62, 95% CI 0.424-0.905, p = 0.0133) and post-procedure epidural opioids (OR 0.485, 95% CI 0.322-0.731, p = 0.0005) being associated with a significant reduction in opioid-induced respiratory depression. CONCLUSIONS Despite varying opioid administration characteristics between Asia, Europe, and the United States, opioid-induced respiratory depression remains a common global problem on general care medical and surgical wards. While the use of post-procedure tramadol or post-procedure epidural opioids may reduce the incidence of respiratory depression, continuous monitoring is also necessary to ensure patient safety when receiving postoperative opioids. REGISTRATION NUMBER: www.clinicaltrials.gov, ID: NCT02811302.
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Affiliation(s)
- Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Sergio D Bergese
- Department of Anesthesiology, and Neurological Surgery, Stony Brook University, Stony Brook, NY, USA
| | - Wolfgang Buhre
- Department of Anesthesiology, University Medical Center, Maastricht, Netherlands
| | - Maria Wittmann
- Department of Anaesthesiology, University Hospital Bonn, Bonn, Germany
| | - Morgan Le Guen
- Department of Anaesthesiology, Hôpital Foch, Suresnes, France
| | | | - Fabio Di Piazza
- Medtronic Core Clinical Solutions, Study and Scientific Solutions, Rome, Italy
| | - Leif Saager
- Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA; Department of Anesthesiology, University Medical Center Goettingen, Germany; Outcomes Research Consortium, Cleveland, OH, USA
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Picardi A, Arcese W, Pollichieni S, Di Piazza F, Mangione I, Gallina AM, Cerretti R, Cudillo L, De Angelis G, Mengarelli A, Dentamaro T, Tirindelli MC, Chierichini A, Ferrari A, Marciano R, Andreani M, Bonifazi F, Sacchi N. The Rome Transplant Network model compared to the Italian Bone Marrow Donor Registry activity for unrelated donor search process and transplant efficiency for hematologic malignancy. Transfusion 2017; 57:1734-1743. [DOI: 10.1111/trf.14131] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/28/2017] [Accepted: 03/03/2017] [Indexed: 12/12/2022]
Affiliation(s)
- Alessandra Picardi
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | - William Arcese
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | | | - Fabio Di Piazza
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | - Ilaria Mangione
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | | | - Raffaella Cerretti
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | - Laura Cudillo
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | - Gottardo De Angelis
- Department of Biomendicina e Prevenzione of Tor Vergata University; Hematology Stem Cell Transplant Unit; Rome Italy
| | - Andrea Mengarelli
- Department of Hematology; Regina Elena National Cancer Institute; Rome Italy
| | | | | | - Anna Chierichini
- Department of Hematology; S. Giovanni Addolorata Hospital; Rome Italy
| | - Antonella Ferrari
- Department of Hematology; S. Andrea Hospital, La Sapienza University; Rome Italy
| | - Renato Marciano
- Italian Bone MarrowDonorRegistry; Ospedale Galliera; Genoa Italy
| | | | - Francesca Bonifazi
- Institute of Hematology "Seràgnoli, University Hospital S. Orsola-Malpighi; Bologna Italy
| | - Nicoletta Sacchi
- Italian Bone MarrowDonorRegistry; Ospedale Galliera; Genoa Italy
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De Felice L, Agostini F, Suriano C, Fraboni D, Gregorj C, Tirindelli MC, Picardi A, Santarone S, Di Piazza F, Di Bartolomeo P, Arcese W. Hematopoietic, Mesenchymal, and Immune Cells Are More Enhanced in Bone Marrow than in Peripheral Blood from Granulocyte Colony-Stimulating Factor Primed Healthy Donors. Biol Blood Marrow Transplant 2016; 22:1758-1764. [DOI: 10.1016/j.bbmt.2016.06.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/22/2016] [Indexed: 11/28/2022]
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Tendas A, Cupelli L, Mauroni MR, Sollazzo F, Di Piazza F, Saltarelli D, Carli I, Chierichini A, Melfa C, Surano MA, Annibali O, Piedimonte M, Conte E, Marchesi F, Viggiani C, Pignatelli AC, Dentamaro T, de Fabritiis P, Perrotti AP, Arcese W. Patient-reported outcomes and quality of life assessment: New targets for new targeted therapy? Cancer 2016; 122:1461-2. [PMID: 26970196 DOI: 10.1002/cncr.29943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Andrea Tendas
- Department of Hematology, S. Eugenio Hospital, Rome, Italy
| | - Luca Cupelli
- Department of Hematology, S. Eugenio Hospital, Rome, Italy
| | - Maria Rita Mauroni
- Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy
| | - Fabio Sollazzo
- Department of Hematology, S. Eugenio Hospital, Rome, Italy
| | - Fabio Di Piazza
- Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy
| | - Debora Saltarelli
- Department of Hematology, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Ilaria Carli
- Department of Hematology, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Anna Chierichini
- Department of Hematology, S. Giovanni Addolorata Hospital, Rome, Italy
| | - Chiara Melfa
- Department of Hematology, University Campus Bio-Medico, Rome, Italy
| | | | | | | | | | - Francesco Marchesi
- Department of Hematology, Regina Elena National Cancer Institute, Rome, Italy
| | - Caterina Viggiani
- Department of Hematology, Regina Elena National Cancer Institute, Rome, Italy
| | | | | | | | | | - William Arcese
- Stem Cell Transplant Unit, Department of Hematology, Tor Vergata University, Rome, Italy
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Tirindelli MC, Flammia GP, Bove P, Cerretti R, Cudillo L, De Angelis G, Picardi A, Annibali O, Nobile C, Cerchiara E, Dentamaro T, De Fabritiis P, Lanti A, Ferraro AS, Sergi F, Di Piazza F, Avvisati G, Arcese W. Fibrin Glue Therapy for Severe Hemorrhagic Cystitis after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2014; 20:1612-7. [DOI: 10.1016/j.bbmt.2014.06.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 06/13/2014] [Indexed: 11/15/2022]
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Del Principe MI, Buccisano F, Maurillo L, Venditti D, Cefalo M, Sarlo C, Di Caprio L, Di Veroli A, Nasso D, Ceresoli E, Postorino M, Di Piazza F, Colandrea G, Conti F, Del Poeta G, Amadori S, Venditti A. Infections increase the risk of central venous catheter-related thrombosis in adult acute myeloid leukemia. Thromb Res 2013; 132:511-4. [PMID: 24090605 DOI: 10.1016/j.thromres.2013.08.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/10/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Central venous catheters (CVC) related thrombosis (CRT) represents a well known complication in patients with acute myeloid leukemia (AML) receiving intensive chemotherapy but the efficacy of antithrombotic prophylaxis still remains controversial. PATIENTS AND METHODS We analyzed 71 consecutive AML patients whose CVC was inserted before each chemotherapy cycle for an overall number of 106 CVC placements. In 47/106 insertions, a prophylaxis with 100 IU/kg/day low molecular weight heparin (LMWH) was administered for 7 days after CVC insertion and additional 7 after CVC removal. This unconventional dose of LMWH, although higher than usual, appeared adequate for a short-course approach. LMWH was delivered regardless of the platelet (PLT) count once provided that it should have been maintained above 20 x 10(9)/L by transfusions. RESULTS Of 106 insertions, we observed 19 (18%) episodes of CRT, 58 (54%) of sepsis and 50 (47%) infections of CVC-exit site with no difference between LMWH and no-LMWH group. Occurrence of CRT was significantly associated with CVC-exit site infections (14/19, p=0.01) and sepsis (16/19, p=0.005) with no difference between LMWH and no-LMWH group. In multivariate analysis, both CVC-exit site infections and sepsis were confirmed to be independent risk factors for CRT development. CONCLUSION Our retrospective study, although based on a small sample size, suggests that the occurrence of CVC-exit site infections and neutropenic sepsis following chemotherapy significantly increases the risk of CRT in AML, independently from the use of LMWH prophylaxis.
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Affiliation(s)
- Maria Ilaria Del Principe
- Cattedra di Ematologia, Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italia.
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