Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial
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 observ...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-10-01
|
| Series: | BMC Anesthesiology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12871-023-02291-x |
| _version_ | 1797556966629834752 |
|---|---|
| author | Anthony G. Doufas Mariana L. Laporta C. Noelle Driver Fabio Di Piazza Marco Scardapane Sergio D. Bergese Richard D. Urman Ashish K. Khanna Toby N. Weingarten The Prediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators |
| author_facet | Anthony G. Doufas Mariana L. Laporta C. Noelle Driver Fabio Di Piazza Marco Scardapane Sergio D. Bergese Richard D. Urman Ashish K. Khanna Toby N. Weingarten The Prediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators |
| author_sort | Anthony G. Doufas |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-10T17:10:40Z |
| format | Article |
| id | doaj.art-fbdd9312ada2458ca912f98f602b8d21 |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-10T17:10:40Z |
| publishDate | 2023-10-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-fbdd9312ada2458ca912f98f602b8d212023-11-20T10:41:57ZengBMCBMC Anesthesiology1471-22532023-10-0123111010.1186/s12871-023-02291-xIncidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trialAnthony G. Doufas0Mariana L. Laporta1C. Noelle Driver2Fabio Di Piazza3Marco Scardapane4Sergio D. Bergese5Richard D. Urman6Ashish K. Khanna7Toby N. Weingarten8The Prediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group InvestigatorsDepartment of Anesthesiology, Perioperative and Pain Medicine, Center for Sleep and Circadian Sciences, Stanford University School of MedicineDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicMedtronic Core Clinical Solutions, Global Clinical Data SolutionsMedtronic Core Clinical Solutions, Global Clinical Data SolutionsDepartment of Anesthesiology and Neurological Surgery, Stony Brook University School of MedicineDepartment of Anesthesiology, The Ohio State University and Wexner Medical CenterSection On Critical Care Medicine, Department of Anesthesiology, Wake Forest Center for Biomedical Informatics, Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of MedicineDepartment of Anesthesiology and Perioperative Medicine, Mayo ClinicAbstract 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.https://doi.org/10.1186/s12871-023-02291-xRespiratory depressionApneaSupplemental oxygenRoom airCapnographyPulse oximetry |
| spellingShingle | Anthony G. Doufas Mariana L. Laporta C. Noelle Driver Fabio Di Piazza Marco Scardapane Sergio D. Bergese Richard D. Urman Ashish K. Khanna Toby N. Weingarten The Prediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY (PRODIGY) Group Investigators 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 Anesthesiology Respiratory depression Apnea Supplemental oxygen Room air Capnography Pulse oximetry |
| title | Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial |
| title_full | Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial |
| title_fullStr | Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial |
| title_full_unstemmed | Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial |
| title_short | Incidence of postoperative opioid-induced respiratory depression episodes in patients on room air or supplemental oxygen: a post-hoc analysis of the PRODIGY trial |
| title_sort | incidence of postoperative opioid induced respiratory depression episodes in patients on room air or supplemental oxygen a post hoc analysis of the prodigy trial |
| topic | Respiratory depression Apnea Supplemental oxygen Room air Capnography Pulse oximetry |
| url | https://doi.org/10.1186/s12871-023-02291-x |
| work_keys_str_mv | AT anthonygdoufas incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT marianallaporta incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT cnoelledriver incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT fabiodipiazza incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT marcoscardapane incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT sergiodbergese incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT richarddurman incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT ashishkkhanna incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT tobynweingarten incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial AT thepredictionofopioidinducedrespiratorydepressioninpatientsmonitoredbycapnographyprodigygroupinvestigators incidenceofpostoperativeopioidinducedrespiratorydepressionepisodesinpatientsonroomairorsupplementaloxygenaposthocanalysisoftheprodigytrial |