A series of presentations from nationally recognized experts included:

Current And Future Objective Monitors Outside The ICU – Dean R. Hess, PhD, RRT (Assistant Director of Respiratory Care, Massachusetts General Hospital; Associate Professor of Anesthesia, Harvard Medical School; Editor in Chief, Respiratory Care)

Examples of Respiratory Compromise – Peter S. Marshall, M.D. MPH (Pulmonary, Critical Care & Sleep Section, Department of Medicine, Yale School of Medicine)

Goals of the Conference – Timothy A. Morris, MD FCCP (President, National Association for Medical Direction of Respiratory Care; Clinical Service Chief, Division of Pulmonary, Critical Care Medicine and Sleep Medical Director of Respiratory Care and Pulmonary Function Laboratory, University of California, San Diego)

Pathophysiology of Respiratory Compromise – Neil MacIntyre, MD (Pulmonologist, Duke University)

Rapid Response Systems (RRS) – Peter Morris, MD (Wake Forest School of Medicine)

Respiratory Compromise; Governmental Regulatory and Fiscal Considerations – James Mathers, MD, FCCP (Medical Policy Consultant at GRQ, LLC)


  1. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology. 2002 Apr;96(4):1004-17., 2002. 96(4): p. 1004-17.
  2. Emergency department visits involving nonmedical use of selected prescription drugs – United States, 2004-2008. MMWR Morb Mortal Wkly Rep. 2010 Jun 18;59(23):705-9., 2010. 59(23): p. 705-9.
  3. Safe use of opioids in hospitals. Sentinel Event Alert. 2012 Aug 8;(49):1-5., 2012(49): p. 1-5.
  4. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014 Feb;120(2):268-86., 2014. 120(2): p. 268-86.
  5. Adams, L., S. Butas, and D. Spurlock, Capnography (ETCO2), respiratory depression, and nursing interventions in moderately sedated adults undergoing transesophageal echocardiography (TEE). J Perianesth Nurs. 2015 Feb;30(1):14-22., 2015. 30(1): p. 14-22.
  6. Addison, P.S., et al., Pulse oximetry-derived respiratory rate in general care floor patients. J Clin Monit Comput, 2015. 29(1): p. 113-20.
  7. Agarwal, S., M. Erslon, and J. Bloom, Hospital cost versus medicare payment for respiratory insufficiency, arrest and failure. Value Health. 2011: 14 (3): A142.: p. A142.
  8. Agarwal, S., M. Erslon, and J. Bloom, Projected incidence and cost of respiratory failure, insufficiency and arrest in medicare population, 2019. AHARM. 2011: June 12-14, 2011.
  9. Agarwal, S., et al., Large national database highlights significant risk factors for respiratory complications and mortality after abdominal surgery. Crit Care Med. 2011: 39 (Suppl 12): 588.: p. 588.
  10. Al-Kindy, H.A., et al., Risk factors for extreme events in infants hospitalized for apparent life-threatening events. J Pediatr. 2009 Mar;154(3):332-7, 337.e1-2., 2009. 154(3): p. 332-7, 337.e1-2.
  11. Al-Sufayan, F., et al., The effects of airway closure in central apneas and obstructed respiratory efforts in mixed apneas in preterm infants. Pediatr Pulmonol. 2009 Mar;44(3):253-9., 2009. 44(3): p. 253-9.
  12. Amann, M., et al., Opioid-mediated muscle afferents inhibit central motor drive and limit peripheral muscle fatigue development in humans. J Physiol. 2009 Jan 15;587(Pt 1):271-83., 2009. 587(Pt 1): p. 271-83.
  13. Arakawa, H., et al., Does pulse oximetry accurately monitor a patient’s ventilation during sedated endoscopy under oxygen supplementation? Singapore Med J. 2013 Apr;54(4):212-5., 2013. 54(4): p. 212-5.
  14. Aronson, A.A., et al., Use of end-tidal carbon dioxide monitoring to detect occult hypoventilation in patients receiving opioids in the pre-hospital and emergency department settings. Chest, 2004. 126(4): p. 907S.
  15. Arozullah, A.M., et al., Multifactorial risk index for predicting postoperative respiratory failure in men after major noncardiac surgery. The National Veterans Administration Surgical Quality Improvement Program. Ann Surg. 2000 Aug;232(2):242-53., 2000. 232(2): p. 242-53.
  16. Arozullah, A.M., et al., Postoperative mortality and pulmonary complication rankings: how well do they correlate at the hospital level? Med Care. 2003 Aug;41(8):979-91., 2003. 41(8): p. 979-91.
  17. Babre, F., et al., Usefulness of oral and nasal capnography in the pediatric recovery room. Anesthesiology, 2004. 101: p. A1503.
  18. Barfod, C., et al., Abnormal vital signs are strong predictors for intensive care unit admission and in-hospital mortality in adults triaged in the emergency department – a prospective cohort study. Scand J Trauma Resusc Emerg Med. 2012;20:28., 2012. 20: p. 28.
  19. Batchelder, K.A., et al., Pulse oximetry saturation patterns detect repetitive reductions in airflow. J Clin Monit Comput. 2011 Dec;25(6):411-8., 2011. 25(6): p. 411-8.
  20. Bazin, J., Detection of respiratory depression prior to evidence of hypoxemia in procedural sedation. Respir Care, 2007. 52: p. aarc07_62.
  21. Beitz, A., et al., Capnographic monitoring reduces the incidence of arterial oxygen desaturation and hypoxemia during propofol sedation for colonoscopy: a randomized, controlled study (ColoCap Study). Am J Gastroenterol. 2012 Aug;107(8):1205-12., 2012. 107(8): p. 1205-12.
  22. Berkenstadt, H., et al., An evaluation of the Integrated Pulmonary Index (IPI) for the detection of respiratory events in sedated patients undergoing colonoscopy. J Clin Monit Comput. 2012 Jun;26(3):177-81., 2012. 26(3): p. 177-81.
  23. Blake, D.W., et al., Postoperative analgesia and respiratory events in patients with symptoms of obstructive sleep apnoea. Anaesth Intensive Care. 2009 Sep;37(5):720-5., 2009. 37(5): p. 720-5.
  24. Bloom, J., et al., The impact of obesity and sleep disordered breathing on postoperative pulmonary complications. Crit Care Med. 2010: 38 (12): A42.: p. A42.
  25. Bloom, J., et al., Incidence and economic impact of and risk factors for respiratory failure after abdominal surgery. Surgical Endoscopy. 2011: 25 ( ): P441.: p. P441.
  26. Bloom, J., et al., Postoperative naloxone rescue following parenteral opioids after abdominal surgery: Incidence and cohort morbidity and mortality. Intensive Care Medicine. 2010: 36 (Suppl 2): S283.: p. S283.
  27. Blouw, E.L., et al., The frequency of respiratory failure in patients with morbid obesity undergoing gastric bypass. AANA J. 2003 Feb;71(1):45-50., 2003. 71(1): p. 45-50.
  28. Blum, J.M., et al., Preoperative and intraoperative predictors of postoperative acute respiratory distress syndrome in a general surgical population. Anesthesiology. 2013 Jan;118(1):19-29., 2013. 118(1): p. 19-29.
  29. Bohnhorst, B., et al., Bradycardia and desaturation during skin-to-skin care: no relationship to hyperthermia. J Pediatr. 2004 Oct;145(4):499-502., 2004. 145(4): p. 499-502.
  30. Bonnin, M., et al., Respiratory adverse effects after intrathecal versus epidural morphine for postoperative analgesia in caesarean section measuring endtidal carbon dioxide. Eur J Anaesthesiol, 2004. 21(Suppl 32): p. 156.
  31. Brock-Utne, J.G., et al., Incidence of airway compromise in morbidly obese patients recovering from general anesthesia after laparoscopic gastric bypass surgery. Eur J Anaesthesiol, 2004. 21(Suppl 32): p. 68.
  32. Brown, K.A., et al., Recurrent hypoxemia in children is associated with increased analgesic sensitivity to opiates. Anesthesiology. 2006 Oct;105(4):665-9., 2006. 105(4): p. 665-9.
  33. Brueckmann, B., et al., Development and validation of a score for prediction of postoperative respiratory complications. Anesthesiology. 2013 Jun;118(6):1276-85., 2013. 118(6): p. 1276-85.
  34. Buist, M., et al., Association between clinically abnormal observations and subsequent in-hospital mortality: a prospective study. Resuscitation. 2004 Aug;62(2):137-41., 2004. 62(2): p. 137-41.
  35. Burke, J., et al., Implementing Microstream end tidal CO2 in the PACU. Journal of PeriAnesthesia Nursing. 2014: 29 (5): e28: p. e28.
  36. Burt, C. and J. Arrowsmith, Respiratory failure. Surgery (Oxford). 2009: 27 (11): 475-479.: p. 475-479.
  37. Burton, J.H., et al., Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices? Acad Emerg Med. 2006 May;13(5):500-4., 2006. 13(5): p. 500-4.
  38. Butler-Williams, C., N. Cantrill, and S. Maton, Increasing staff awareness of respiratory rate significance. Nurs Times. 2005 Jul 5-11;101(27):35-7., 2005. 101(27): p. 35-7.
  39. Canet, J. and L. Gallart, Postoperative respiratory failure: pathogenesis, prediction, and prevention. Curr Opin Crit Care. 2014 Feb;20(1):56-62., 2014. 20(1): p. 56-62.
  40. Canet, J. and V. Mazo, Postoperative pulmonary complications. Minerva Anestesiol. 2010 Feb;76(2):138-43., 2010. 76(2): p. 138-43.
  41. Cashman, J.N. and S.J. Dolin, Respiratory and haemodynamic effects of acute postoperative pain management: evidence from published data. Br J Anaesth. 2004 Aug;93(2):212-23. Epub 2004 May 28., 2004. 93(2): p. 212-23.
  42. Chaboyer, W., et al., Predictors of adverse events in patients after discharge from the intensive care unit. Am J Crit Care. 2008 May;17(3):255-63; quiz 264., 2008. 17(3): p. 255-63; quiz 264.
  43. Chen, J., et al., The impact of introducing medical emergency team system on the documentations of vital signs. Resuscitation. 2009 Jan;80(1):35-43., 2009. 80(1): p. 35-43.
  44. Chow, J.L., et al., Incidence of airway compromise in cardiac patients undergoing conscious sedation for implantable cardioverter defibrillator placement. Eur J Anaesthesiol, 2004. 21(Suppl 32): p. 65-66.
  45. Chung, F., et al., Validation of the Berlin questionnaire and American Society of Anesthesiologists checklist as screening tools for obstructive sleep apnea in surgical patients. Anesthesiology. 2008 May;108(5):822-30., 2008. 108(5): p. 822-30.
  46. Cooper, S., M. Janghorbani, and G. Cooper, A decade of in-hospital resuscitation: outcomes and prediction of survival? Resuscitation. 2006 Feb;68(2):231-7., 2006. 68(2): p. 231-7.
  47. Cretikos, M.A., et al., Respiratory rate: the neglected vital sign. Med J Aust. 2008 Jun 2;188(11):657-9., 2008. 188(11): p. 657-9.
  48. Curry, J.P. and C.M. Hanna, Disparate incidence of hypoxemia in patients post midline abdominal surgery: Man versus machine. Anesthesiology. 2002: 96 A1173: p. A1173.
  49. Curry, J.P. and C.R. Jungquist, A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review. Patient Saf Surg. 2014;8:29., 2014. 8: p. 29.
  50. Dahan, A., L. Aarts, and T.W. Smith, Incidence, Reversal, and Prevention of Opioid-induced Respiratory Depression. Anesthesiology. 2010 Jan;112(1):226-38., 2010. 112(1): p. 226-38.
  51. Davidson, K. and V. Barber, Electronic monitoring of patients in general wards. Nurs Stand. 2004 Aug 18-24;18(49):42-6., 2004. 18(49): p. 42-6.
  52. Deitch, K., C.R. Chudnofsky, and P. Dominici, The utility of supplemental oxygen during emergency department procedural sedation with propofol: a randomized, controlled trial. Ann Emerg Med. 2008 Jul;52(1):1-8., 2008. 52(1): p. 1-8.
  53. Deitch, K., et al., The utility of high-flow oxygen during emergency department procedural sedation and analgesia with propofol: a randomized, controlled trial. Ann Emerg Med. 2011 Oct;58(4):360-364.e3., 2011. 58(4): p. 360-364.e3.
  54. Deitch, K., et al., Does end tidal CO2 monitoring during emergency department procedural sedation and analgesia with propofol decrease the incidence of hypoxic events? A randomized, controlled trial. Ann Emerg Med. 2010 Mar;55(3):258-64., 2010. 55(3): p. 258-64.
  55. Deitch, K., et al., Unrecognized hypoxia and respiratory depression in emergency department patients sedated for psychomotor agitation: pilot study. West J Emerg Med. 2014 Jul;15(4):430-7., 2014. 15(4): p. 430-7.
  56. Delius, S., et al., Capnography improves patient safety during propofol sedation for colonoscopy: A randomized, controlled study (ColoCap study). Anesthesiology. 2011: 115 A1657: p. A1657.
  57. DeVita, M.A., et al., “Identifying the hospitalised patient in crisis”–a consensus conference on the afferent limb of rapid response systems. Resuscitation. 2010 Apr;81(4):375-82., 2010. 81(4): p. 375-82.
  58. Dimick, J.B., et al., Hospital costs associated with surgical complications: a report from the private-sector National Surgical Quality Improvement Program. J Am Coll Surg. 2004 Oct;199(4):531-7., 2004. 199(4): p. 531-7.
  59. Eckstrand, J.A., et al., Computerized surveillance of opioid-related adverse drug events in perioperative care: a cross-sectional study. Patient Saf Surg. 2009;3(1):18., 2009. 3(1): p. 18.
  60. Fecho, A., L. Joyner, and D. Pfeiffer, Opioids and code blue emergencies. Anesthesiology. 2008: 109 A34: p. A34.
  61. Fecho, K., et al., In-hospital resuscitation: opioids and other factors influencing survival. Ther Clin Risk Manag. 2009;5:961-8., 2009. 5: p. 961-8.
  62. Finkel, K.J., et al., Prevalence of undiagnosed obstructive sleep apnea among adult surgical patients in an academic medical center. Sleep Med. 2009 Aug;10(7):753-8., 2009. 10(7): p. 753-8.
  63. Fischer, J.P., et al., Validated model for predicting postoperative respiratory failure: analysis of 1706 abdominal wall reconstructions. Plast Reconstr Surg. 2013 Nov;132(5):826e-835e., 2013. 132(5): p. 826e-835e.
  64. Flisberg, P., et al., Pain relief and safety after major surgery. A prospective study of epidural and intravenous analgesia in 2696 patients. Acta Anaesthesiol Scand. 2003 Apr;47(4):457-65., 2003. 47(4): p. 457-65.
  65. Folke, M., et al., Critical review of non-invasive respiratory monitoring in medical care. Med Biol Eng Comput. 2003 Jul;41(4):377-83., 2003. 41(4): p. 377-83.
  66. Frattari, A., et al., Microstream capnography improves patient monitoring during deep sedation. Digestive and Liver Disease, 2010. 42(Suppl 5): p. S330.
  67. Friedrich-Rust, M., et al., Capnographic monitoring of propofol-based sedation during colonoscopy. Endoscopy. 2014 Mar;46(3):236-44., 2014. 46(3): p. 236-44.
  68. Gali, B., et al., Identification of patients at risk for postoperative respiratory complications using a preoperative obstructive sleep apnea screening tool and postanesthesia care assessment. Anesthesiology. 2009 Apr;110(4):869-77., 2009. 110(4): p. 869-77.
  69. Gallagher, S.F., et al., Postoperative Hypoxemia: Common, Undetected, and Unsuspected After Bariatric Surgery1. J Surg Res. 2010 Apr;159(2):622-6., 2010. 159(2): p. 622-6.
  70. Gozal, Y. and D. Gozal, The Integrated Pulmonary Index: Validity and application in the pediatric population. Anesth Analg, 2009. 109: p. 2.
  71. Gozal, Y. and D. Gozal, Validation of the Integrated Pulmonary Index in the post anesthesia care unit. Eur J Anaesthesiol, 2009. 26(Suppl 45): p. 36.
  72. Gross, J.B., et al., Practice guidelines for the perioperative management of patients with obstructive sleep apnea: a report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2006 May;104(5):1081-93; quiz 1117-8., 2006. 104(5): p. 1081-93; quiz 1117-8.
  73. Grosse-Sundrup, M., et al., Intermediate acting non-depolarizing neuromuscular blocking agents and risk of postoperative respiratory complications: prospective propensity score matched cohort study. BMJ. 2012;345:e6329., 2012. 345: p. e6329.
  74. Gupta, A., M. Ashburn, and J. Ballantyne, Quality assurance and assessment in pain management. Anesthesiol Clin. 2011 Mar;29(1):123-33., 2011. 29(1): p. 123-33.
  75. Gupta, P.K., et al., Postoperative respiratory failure after thyroid and parathyroid surgery: analysis of national surgical quality improvement program. Head Neck. 2012 Mar;34(3):321-7., 2012. 34(3): p. 321-7.
  76. Gwirtz, K.H., et al., The safety and efficacy of intrathecal opioid analgesia for acute postoperative pain: seven years’ experience with 5969 surgical patients at Indiana University Hospital. Anesth Analg. 1999 Mar;88(3):599-604., 1999. 88(3): p. 599-604.
  77. Hack, H., Use of preoperative overnight oximetry data in children with obstructive sleep apnoea undergoing adenotonsillectomy with a low dose opiate and multi-modal perioperative analgesic regime is associated with a low incidence of postoperative respiratory complications; combined results of a three stage audit process. Pediatric Anesthesia. 2013: 23 (3): 285-291: p. 285-291.
  78. Hack, H., Use of a low dose opiate/multi modal analgesic regime to reduce respiratory complications in children with obstructive sleep apnoea following adenotonsilectomy. Paediatric Anaesthesia, 2012. 22(9): p. 923-924.
  79. Hack, H., An audit of the use of an opiate sparing, multimodal analgesic regime in children with Sleep Disordered Breathing/Obstructive Sleep Apnoea undergoing adenotonsillectomy. Int J Pediatr Otorhinolaryngol. 2014 Jan;78(1):119-23., 2014. 78(1): p. 119-23.
  80. Hallowell, P.T., et al., Potentially life-threatening sleep apnea is unrecognized without aggressive evaluation. Am J Surg. 2007 Mar;193(3):364-7; discussion 367., 2007. 193(3): p. 364-7; discussion 36.
  81. Hancock, J., et al., Could capnography play any useful role in monitoring sedated patients on an endoscopy unit? Gut, 2005. 54(Suppl 2): p. A64.
  82. Harris, A.T., et al., A discussion of airway and respiratory complications along with general considerations in obese patients. Int J Clin Pract.