Frequent respiratory events in postoperative patients aged 60 years and above

Broens, Suzanne J.L.; He, Xuan; Evley, Rachel; Olofsen, Erik; Niesters, Marieke; Mahajan, Ravi P.; Dahan, Albert; van Velzen, Monique

Abstract

There is limited information on the occurrence of respiratory events in postoperative patients after discharge from the postanesthesia care unit. We studied the respiratory rate (RR) of 68 patients aged 60 years and above during the first 6 hours following elective surgery under general anesthesia to assess the frequency of respiratory events in the care unit and on the ward. RR was derived from the continuous RR counter RespiR8, measuring RR by quantifying the humidity of exhaled air. One-minute-averaged RRs were collected and analyzed to assess the frequency of postoperative bradypnea (RR 1–6 breaths/minute) and apnea (cessation of inspiratory flow $60
seconds). Values were median (interquartile range) or mean (SD). The median RR was 13 (10–15) breaths/minute. In the 6-hour postoperative period, 78% and 57% of patients experienced at least
one bradypnea or apnea event, respectively. A median of ten (3.5–24) bradypnea and three (1–11) apnea events were detected per patient. The occurrence of respiratory events in the postanesthesia care unit (PACU) was a predictor of events on the ward (bradypnea, r2
=0.4, P less than 0.001; apnea, r2=0.2, P less than 0.001). Morphine consumption correlated weakly with respiratory events in the PACU,
but not on the ward. Patients with apnea had significantly larger neck circumference than patients without (39.6 [0.7] versus 37.4 [0.8] cm, P less than 0.05). Bradypneic or apneic respiratory events are frequent in postoperative elderly patients and even occur relatively late after surgery. Continuous respiratory monitoring on the ward, especially in patients with risk factors, such as early occurrence of events, opioid use, and larger neck circumference, is likely warranted.

• Journal Article Type: Article
• Acceptance Date: Jun 19, 2017
• Online Publication Date: Aug 26, 2017
• Publication Date: Sep 13, 2017
• Deposit Date: Apr 19, 2018
• Publicly Available Date: Jun 26, 2019
• Journal: Therapeutics and Clinical Risk Management
• Print ISSN: 1176-6336
• Electronic ISSN: 1178-203X
• Publisher: Dove Medical Press
• Peer Reviewed: Peer Reviewed
• Volume: 13
• Pages: 1091-1098
• DOI: https://doi.org/10.2147/TCRM.S135923
• Keywords: aged, monitoring, physiologic, postoperative period, respiratory insufficiency, respiratory rate
• Public URL: https://nottingham-repository.worktribe.com/output/1127629
• Publisher URL: https://www.dovepress.com/frequent-respiratory-events-in-postoperative-patients-aged-60-years-an-peer-reviewed-article-TCRM
• PMID: 28894372