Abstract
Background:
Patients receiving opioids are at risk of morbidity and death due to opioid-induced respiratory depression (OIRD). Time to discharge is decreasing, pushing these risks into the home setting. Monitoring systems with alarms may avert post-discharge OIRD. The feasibility of such systems for home monitoring has limited study. It is our impression rather than just OSA, an inadequate minute ventilation induced by opioids and /or polypharmacy of central nervous system depressing drugs, may be contributing factors to OIRD.
Methods:
TOSH is the stand-alone hospital for orthopedic care within Intermountain Healthcare. Opioids can: 1) directly inhibit respiratory musculature function from the upper airway to the diaphragm, 2) impair hypoxic/hypercapnic ventilatory response, 3) alter control of breathing at the medulla and pons, and 4) impair arousal response. With an Intermountain Research and Medical Foundation grant, we began a quantitative, prospective, non-randomized, single cohort study using Masimo RAD 97 monitoring devices to test the feasibility of 4-day, home monitoring. Oxygen saturation (SpO2), HR, RR and capnography (ETCO2) were recorded. Patients meeting high-risk opioid inclusion criteria and prescribed opioids were included. Patients were educated about risks of OIRD and other CNS depressing medications, alarm response, Narcan administration and when to call 911. They were given a 24/7 number to call with questions/concerns. Upon device return, all recorded data were analyzed including pre-/post-study surveys given to patients.
Results:
The study target was 500 enrolled patients or 6-months, whichever comes first. As of May 13, 2020, 235 patients have been enrolled in the study. Detailed post-study patient survey results are reported in Table One.
Conclusions:
The majority of patients were willing to participate in additional studies but were split on allowing camera/video for communication in homes. Patients reported ETCO2 over-alarming. Masimo coordinated with researchers to identify a software issue and adjusted to allow for actionable alarming. One patient used Narcan after discharge, was aroused and caregivers called 911. Two patients with frequent alarms sounding during the night were admitted to the hospital and diagnosed with “opioid induced non-ST elevated myocardial infarction” and “opioid induced renal hypoxia/failure” respectively. It is our impression without this study raising the awareness of opioid risks and alarms alerting, these patient conditions may have gone unalerted, unrecognized, and delayed treatment.
*Research team worked with Masimo to report issues & provided evidence to which Masimo engineers revised software. View all access options for this article.High-Risk Opioid Orthopedic Patient Home Monitoring Post-Study Patient Survey Outcomes
Post-Study Results of Patients: September 23, 2019 through May 13, 2020
Total Ptsn=235# (%)
Post-surveys Completed & Returned
235 (100)
Pts Who Felt Safer While Using the Monitoring Device
89 (38)
Caregivers OR Family Members That Felt Safer When Pts Were Using the Monitoring Device
98 (42)
Pts Who Felt Discomfort Wearing Oximetry Sensor on the Finger
46 (20)
Pts Who Felt Discomfort Wearing ETCO2 Cannula
53 (23)
Pts Who Called the Number Provided OR Went to the ER/Urgent Care in Response to An Alarm
27 (11)
Pts at Home Who Used Naloxone/Narcan (Reversal) Medication Given to Them Prior to Discharge
1 (<1)
Pts or Caregivers Feeling Monitor Had Too Many False Alarms
115 (49)*
Pts Who Would Undergo Home Monitoring in The Future If It Was Felt to Be Needed to Ensure Safety
149 (63)
Pts Who Think That Having A Healthcare Provider Who Can Respond to Alarms by Seeing/Speaking Them Through A Remote Camera Would Make Them Feel Safer/More Comfortable Than the Current Monitoring System
85 (36)
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