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Respiratory Compromise Blog

The RCI aims to reduce the incidence and consequences of Respiratory Compromise through increased awareness and education. Through the RCI alliance, healthcare professionals across specialties are working together to diagnose and treat Respiratory Compromise.

Read more about the RCI’s position on current topics pertaining to Respiratory Compromise, as well as our initiatives to encourage updated strategies for the early identification of Respiratory Compromise.

Respiratory Compromise Institute (RCI) Issues New Educational Video Series to Raise Awareness of Respiratory Compromise

by Michael Wong

RCI Seeks to Educate and Collaborate with the Medical Community
 to End Respiratory Compromise

VIENNA, VA, September 10, 2019—The Respiratory Compromise Institute (RCI) announced today the launch of an educational video series of industry-leading medical experts discussing respiratory compromise, a pulmonary condition generally characterized by the chronic or acute deterioration of respiratory function. This provider education series is intended to promote a multidisciplinary dialogue among the medical community, especially in hospital settings, such as pulmonologists, anesthesiologists, hospitalists, respiratory therapists, critical care experts, emergency physicians, nurse anesthetists, chest physicians, medical academia, and others who are responsible for patient safety.

“Respiratory failure is the second leading avoidable patient safety issue,1” states Phil Porte, Executive Director of RCI. This video series, to be released over the next several weeks, will provide important information on the current research and next steps to preventing respiratory compromise in hospitals across the nation and around the world. The series will consist of 16 topics and 13 additional patient safety videos, and feature opinions from physicians and thought leaders like Dr. Wolfgang Buhre, Dr. Ashish K. Khanna, Dr. Toby N. Weingarten, Dr. Lian Kah Ti, Dr. Sabry Ayad, and Dr. Carla Jungquist.

The Respiratory Compromise video series will cover topics including:

  • The Importance of Respiratory Compromise (RC). 
  • Geographical Differences in RC. 
  • Current and Ideal Monitoring Standards of Care.
  • The Role of and Barriers to Continuous Monitoring.
  • The Role of Capnography in Preventing RC.

About Respiratory Compromise
Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent.2

About Respiratory Compromise Institute 
The Respiratory Compromise Institute brings together a broad-based coalition of medical organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.3,4

Learn more about the Respiratory Compromise Institute by visiting: https://www.respiratorycompromise.org/

References

1 Healthgrades website, “Quality Matters: Tackle the Top 3 Patient Safety Issues.” 
https://www.hospitals.healthgrades.com/index.cfm/customers/e-newsletters/april-2013/quality-matters-tackle-the-top-3-patient-safety-issues/. Accessed October 10, 2017.

2 Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012; 40(12):764.

3 NAMDRC, National Association for Medical Direction of Respiratory Care. Reducing respiratory compromise and depression. PR Web. Available at http://www.prweb.com/pdfdownload/12615503.pdf.

4 Timothy A Morris, Peter C Gay, Neil R MacIntyre, Dean R Hess, Sandra K Hanneman, James P Lamberti, Dennis E Doherty, Lydia Chang, Maureen A Seckel. Respiratory Compromise as a New Paradigm for the Care of Vulnerable Hospitalized Patients. Respiratory Care Apr 2017, 62 (4) 497-512; DOI: 10.4187/respcare.05021

###

Media Contact:  

Nancy Rose Senich

Cell/Text: (202)262-6996

Email:  nancy@rose4results.com 

Why Hospitalists should care about Respiratory Compromise

by Michael Wong

This week is the Society for Hospital Medicine (SHM)’s Annual Conference, and the Respiratory Compromise Institute (RCI) believes that hospitalists play a key part in the prevention – and eventual elimination – of respiratory compromise. Dr. Jeff Vender, who serves on RCI’s clinical advisory committee, has written an article published in “The Hospitalist” on why this is.

Respiratory Compromise is a state in which there is a high likelihood of decompensation into respiratory failure and/or death, but, in which specific interventions – be it therapeutic and/or monitoring – might prevent or mitigate this decompensation. “Respiratory failure is the second leading avoidable patient safety issue.1 It is one of the top five conditions leading to increasing hospital costs2 and the third most rapidly increasing hospital inpatient cost in the United States.3,” states Phil Porte, Executive Director of the Respiratory Compromise Institute.

Dr. Vender begins his article with a reference to research conducted by Dr. Adriana Ducci, on “Improving Survival from Sepsis in Noncritical Units: Role of Hospitalists and Sepsis Team in Early Detection and Initial Treatment of Septic Patients,” and makes a comparison between sepsis and respiratory compromise. Sepsis has been successfully prevented countless times because of hospitalist-managed protocols, and he believes that the same principles apply to respiratory compromise.

“I believe that greater awareness about respiratory compromise will lead to earlier diagnosis and interventions, which will theoretically improve patient outcomes. Moreover, as with the sepsis awareness campaign, hospitalists can play a key role in recognizing respiratory compromise and in the implementation of appropriate interventions,” says Dr. Vender in the article.

Dr. Vender discusses several examples of how respiratory compromise can occur, and offers a few suggestions on steps we can take together as nurses, hospitalists, or physicians, but most importantly he emphasizes that “simple recognition and greater awareness of respiratory compromise, just as with sepsis awareness campaigns, will mean more patients are diagnosed earlier, more appropriate interventions are made, and hopefully more adverse events and patient deaths are averted.”

Read the full article from The Hospitalist here, and join the conversation about respiratory compromise and ways to prevent it by leaving a comment, or following RCI on Twitter, LinkedIn, or Facebook.

Respiratory Compromise Institute (RCI) Issues New Podcast Series to Raise Awareness of Respiratory Compromise

by Michael Wong

VIENNA, Va., March 26, 2019 /PRNewswire/ — The Respiratory Compromise Institute (RCI) announced today the launch of the RCI podcast series, featuring industry-leading medical experts discussing respiratory compromise, a pulmonary condition generally characterized by the chronic or acute deterioration of respiratory function. Respiratory compromise in any form contributes to a higher risk of life-threatening respiratory failure. This provider education series is intended to promote a multidisciplinary dialogue among the medical community, especially in hospital settings, such as pulmonologists, anesthesiologists, hospitalists, respiratory therapists, critical care experts, emergency physicians, nurse anesthetists, chest physicians, medical academia, and other stakeholders who are responsible for patient safety, improving quality measures and promoting optimal clinical outcomes.

“Respiratory failure is the second leading avoidable patient safety issue.1 It is one of the top five conditions leading to increasing hospital costs2 and the third most rapidly increasing hospital inpatient cost in the United States.3,” states Phil Porte. Executive Director of the Respiratory Compromise Institute.  “General care floor patients with respiratory compromise are 29 times more likely to die due to these complications,2” he stated. This podcast series will provide important information on the current research and next steps to preventing respiratory compromise in hospitals across the nation and around the world.

The presentations in the available RCI podcast episodes were delivered at a recent gathering of respiratory therapists and allied medical providers at American Association of Respiratory Care (AARC18) in Las Vegas, Nevada on the following topics:

  • Introduction and Moderation presented by Dr. James Lamberti, MD, FCCP, Director, Respiratory Care Services at Inova Fairfax Hospital, Professor of Medicine, Virginia Commonwealth University School of Medicine, Inova Campus
  • History of Respiratory Compromise Institute (RCI) presented by Phillip Porte, RCI, Executive Director
  • Populations at Risk: Evidence from Medicare Data Mining presented by Dr. Lamberti, MD, FCCP, Director, Respiratory Care Services at Inova Fairfax Hospital, Professor of Medicine, Virginia Commonwealth UniversitySchool of Medicine, Inova Campus and Dr. Sidney Braman, MD, FCCP, Ichan School of Medicine at Mount Sinai
  • Future Research Considerations presented by Dr. Jeffery Vender, MD, FCCP, Evanston Hospital and Dr. Neil MacIntyre, MD, FCCP, Duke University Hospital

About Respiratory Compromise
Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies).

About Respiratory Compromise Institute 
The Respiratory Compromise Institute brings together a broad-based coalition of medical organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.

Learn more about the Respiratory Compromise Institute by visiting: https://www.respiratorycompromise.org/

References

1 Healthgrades website, “Quality Matters: Tackle the Top 3 Patient Safety Issues.” 
https://www.hospitals.healthgrades.com/index.cfm/customers/e-newsletters/april-2013/quality-matters-tackle-the-top-3-patient-safety-issues/. Accessed October 10, 2017.

2 Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012; 40(12):764.

3 NAMDRC, National Association for Medical Direction of Respiratory Care. Reducing respiratory compromise and depression. PR Web. Available at http://www.prweb.com/pdfdownload/12615503.pdf.

Media Contact:  
Nancy Rose Senich
Cell/Text: (202)262-6996
Email:  nancy@rose4results.com

SOURCE Respiratory Compromise Institute (RCI)

Related Links
https://www.respiratorycompromise.org

Respiratory Compromise Institute (RCI) Issues Provider Education Presentations to Raise Awareness of Respiratory Compromise

by Michael Wong

VIENNA, Va., Jan. 22, 2019 /PRNewswire/ — The Respiratory Compromise Institute (RCI) announced today the launch of a series of video presentations of industry-leading medical experts discussing respiratory compromise, a pulmonary condition generally characterized by the chronic or acute deterioration of respiratory function. Respiratory compromise in any form contributes to a higher risk of life-threatening respiratory failure. This provider education series is intended to promote a multidisciplinary dialogue among the medical community, especially in hospital settings, such as pulmonologists, anesthesiologists, hospitalists, respiratory therapists, critical care experts, emergency physicians, nurse anesthetists, chest physicians, medical academia, and other stakeholders who are responsible for patient safety, improving quality measures and promoting optimal clinical outcomes.

“Respiratory failure is the second leading avoidable patient safety issue.1 It is one of the top five conditions leading to increasing hospital costs2 and the third most rapidly increasing hospital inpatient cost in the United States.3,” states Phil Porte, Executive Director of the Respiratory Compromise Institute.  “General care floor patients with respiratory compromise are 29 times more likely to die due to these complications,2” he stated. This video series will provide important information on the current research and next steps to preventing respiratory compromise in hospitals across the nation and around the world.

The presentations in the RCI video series were delivered at a recent gathering of respiratory therapists and allied medical providers at American Association of Respiratory Care (AARC18) in Las Vegas, Nevada on the following topics:

  • Overview of Respiratory Compromise Institute (RCI) Symposium (RCI-AARC18 Summary Video)
  • Introduction and Moderation presented by Dr. James Lamberti, MD, FCCP, Director, Respiratory Care Services at Inova Fairfax Hospital, Professor of Medicine, Virginia Commonwealth University School of Medicine, Inova Campus
  • History of Respiratory Compromise Institute (RCI) presented by Phillip Porte, RCI, Executive Director
  • Populations at Risk: Evidence from Medicare Data Mining presented by Dr. Lamberti, MD, FCCP, Director, Respiratory Care Services at Inova Fairfax Hospital, Professor of Medicine, Virginia Commonwealth UniversitySchool of Medicine, Inova Campus and Dr. Sidney Braman, MD, FCCP, Ichan School of Medicine at Mount Sinai
  • Future Research Considerations presented by Dr. Jeffery Vender, MD, FCCP, Evanston Hospital and Dr. Neil MacIntyre, MD, FCCP, Duke University Hospital

To access the series on RCI’s You Tube channel, please visit http://bit.ly/RCI-ProviderEd2018

About Respiratory Compromise
Respiratory compromise, which includes respiratory distress, insufficiency, failure, and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies).

About Respiratory Compromise Institute 
The Respiratory Compromise Institute brings together a broad-based coalition of medical organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.

Learn more about the Respiratory Compromise Institute by visiting: https://www.respiratorycompromise.org/

References

1 Healthgrades website, “Quality Matters: Tackle the Top 3 Patient Safety Issues.” 
https://www.hospitals.healthgrades.com/index.cfm/customers/e-newsletters/april-2013/quality-matters-tackle-the-top-3-patient-safety-issues/. Accessed October 10, 2017.

2 Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012; 40(12):764.

3 NAMDRC, National Association for Medical Direction of Respiratory Care. Reducing respiratory compromise and depression. PR Web. Available at http://www.prweb.com/pdfdownload/12615503.pdf.

RCI Launches Study of Unplanned Intubations to Better Understand Respiratory Compromise

by Michael Wong

Duke Study Press Release 09/19/18 — Study Aims to Assess Demographic, Clinical Characteristics and Care Practices That Increase Patients’ Risk for Potentially Deadly Condition  

DURHAM, N.C. — The Respiratory Compromise Institute today announced the initiation of a clinical study aimed at better understanding the prevalence, risk factors and pathways for unplanned airway intubations as a measure of respiratory compromise. Respiratory compromise is a deterioration of respiratory function that poses a high risk of life-threatening respiratory failure, the second leading avoidable patient safety issue.1 General care floor patients with respiratory compromise are 29 times more likely to die.2

Led by Neil MacIntyre, MD, FCCP, Professor of Medicine (Pulmonary, Allergy and Critical Care Medicine) at Duke University School of Medicine, and supported by the Respiratory Compromise Institute (RCI), the study will draw on the electronic health records of patient encounters at DUHS’ three hospitals: Duke University Hospital (DUH), Duke Regional Hospital (DRH) and Duke Raleigh Hospital (DRAH). 

The study researchers hope to assess demographic, clinical and care practice characteristics that impact the risk profile of patients 18 years or older with unplanned intubations 24 hours or more after admission or surgery on general medical and surgical floors. The source population will include patients at DUH, DRH and DRAH admitted from January 1, 2014 to December 31, 2017. DUH is a large, 957-acute care bed academic facility, providing tertiary referral care for North Carolina; DRH is a 369-bed community-based facility attending to underserved populations in Durham County, North Carolina; and DRAH is a 186-bed facility serving Raleigh, North Carolina.  

“Our study uses unplanned intubations as an end result of progressive respiratory compromise, which may be difficult to detect early and have a high incidence in minimally monitored care settings, such as medical and surgical floors,” said Dr. MacIntyre. “If we can identify which patient characteristics and aspects of clinical practice present the greatest risk, then healthcare providers will be better positioned to prevent or mitigate respiratory compromise. Furthermore, we believe that, by creating a data and analytics framework that can be adapted to other institutions, our study will serve as a model for future research.”

Demographic data that investigators will be examining to assess patient risk for respiratory compromise include: age, race/ethnicity, sex, smoking and alcohol status. Researchers will also be looking at vital signs, laboratory data and clinical picture along with pre-existing medical conditions, such as diabetes, liver disease, cancer and other factors that can increase patients’ risk. The impact of commonly prescribed medications, including benzodiazepines and sleep aids, will also be assessed. 

“Electronic health records enable us to amass large quantities of data on patients, which can and should be utilized to understand patient risk for a variety of health conditions that arise during in-hospital patient care,” said Phillip Porte, Executive Director of RCI. “Innovative research like the kind being conducted by Dr. MacIntyre will help us continue to deepen our understanding of and hopefully better recognize and prevent respiratory compromise, which has been the aim of the Respiratory Compromise Institute since its founding.”  

The study’s expected completion date is end of 2018. Dr. MacIntyre’s co-investigators include: Armando Bedoya, MD, MMCi, Nrupen Bhavsar, PhD, MPH, and Benjamin Goldstein, PhD, MPH.  

About Respiratory Compromise
Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory failure is the fourth most common patient safety event.3 In patient respiratory compromise costs are expected to surpass $37 billion by 2019.4 Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies).

About Respiratory Compromise Institute
The Respiratory Compromise Institute brings together a broad-based coalition of organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.

References

  1. Healthgrades website, “Quality Matters: Tackle the Top 3 Patient Safety Issues.” 
  2. Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012; 40(12):764.
  3. 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy Content Last Reviewed May 2016. Rockville, MD: Agency for Healthcare Research and Quality; April 2016.
  4. Agarwal SJ, Erslon MG, Bloom JD. Projected incidence and cost of respiratory failure, insufficiency and arrest in Medicare population, 2019. Abstract presented at Academy Health Congress, June 2011.

2018 NAEMSP Annual Meeting Features More Than 50 Education, Research and General Sessions, Highlighting the Importance of EMS

by Michael Wong

Meeting Underscores the Value of Technology and Innovation in EMS Care, Including the Use of Capnography 

levy

By Michael Levy, MD, FACEP, FACP, FAEMS (Secretary/Treasurer, National Association of EMS Physicians)

Since its founding in 1984, the National Association of EMS Physicians’ (NAEMSP) mission has been to create and support a peer organization to serve as a resource and an advocate for EMS physicians and non-physician providers, and, in doing so, foster excellence in out-of-hospital emergency medical services. As an association of more than 1,100 physicians, paramedics, nurses, administrators, educators, researchers, and EMS personnel, NAEMSP convenes every January, bringing together members from across the country and the globe — including attendees from Europe, Asia, Latin America, the Middle East and Canada — to network and learn. At each meeting, members and NAEMSP leadership share new research, host skills and development workshops, and provide updates on best practices.

The 2018 NAEMSP annual meeting continued to demonstrate the organization’s leadership in advancing the care of patients, featuring more than 50 education, research, and general sessions representing the depth and breadth of EMS practice. In addition, days of research posters and oral presentations of abstracts on new science were hosted throughout the meeting.

Key highlights from 2018 NAEMSP, included:

  • a three-day National EMS Medical Directors Course & Practicum, which provided participants with the skills they need to become EMS medical directors;
  • sessions on a new approach to EMS, called Mobile Integrated Healthcare (MIH), which aims to improve patient care and reduce costs;
  • an Out-of-Hospital Critical Procedure Cadaver Lab, which provided a review of anatomy associated with critical care; and
  • a session, entitled “Cutting the Edge: Innovations in Prehospital Critical Care,” which examined concepts and technologies for prehospital care transports.

Capnography — a patient monitoring tool which measures exhaled carbon dioxide — is one such technology and can prevent respiratory compromise, a state in which there is a high likelihood of patient deterioration into respiratory insufficiency, respiratory failure or death.

National EMS Medical Directors Course & Practicum

The three-day National EMS Medical Directors Course & Practicum provided participants with a foundation upon which to function effectively as EMS medical directors. Among other skills, participants learned how to: outline organizational and design options for EMS systems, including system staffing and response configurations; identify the major communications and dispatch issues for EMS systems; describe the process for incident review and strategies for problem-solving in EMS systems; define the fundamentals and priorities for implementing quality improvement programs in EMS systems; and compare and contrast rural, urban, international, and suburban EMS delivery systems. The practicum was sold out, as it was last year, reflecting the growing interest in understanding how to lead an EMS team, and how EMS functions within the broader emergency care system at all levels.

Mobile Integrated Healthcare

Several sessions focused on a new platform for EMS known as Mobile Integrated Healthcare (MIH), featuring healthcare providers with established MIH programs offering guidance to practitioners looking to create their own MIH programs and those with established programs connecting with colleagues to discuss solutions to challenges. MIH envisions EMS playing a key role in healthcare by provisioning — in the out-of-hospital environment — patient-centered, mobile care, which can include: the use of community paramedicine (CP), helping patients with chronic disease management, employing preventive care strategies, conducting post-discharge follow-up visits with patients, or referring them to care settings outside the emergency department. Conceptually, MIH is grounded within the Institute for Healthcare Improvement’s IHI Triple Aim philosophy of improving the patient care experience, improving population health, and reducing the per capita cost of healthcare. Hallmarks of an effective MIH program include, among others:

  • integrating the program into existing healthcare systems;
  • collaborating with local community stakeholders to better understand and define community health needs;
  • using data to develop evidence-based performance measures;
  • having a multidisciplinary approach to medicine, engaging physicians and other clinicians to oversee the MIH program, alongside the patient’s primary care network, and using telemedicine as needed;
  • and providing specialized training to CP personnel.

As part of a MIH program, CP personnel would help bridge the many gaps we find in healthcare systems and avoid unneeded hospital readmissions by providing at-home, focused interventions. CP practitioners would reduce the burden of these readmissions by working with a MIH program team to assess patient needs and respond accordingly, saving patients trips to the emergency room.

Out-of-Hospital Critical Procedure Cadaver Lab

The Out-of-Hospital Critical Procedure Cadaver Lab provided participants with an opportunity to review anatomy associated with critical care, such as the airway and chest cavity, and lifesaving emergency procedures, such as vascular access. Vascular access is especially important when performing extracorporeal cardiopulmonary resuscitation (ECPR). ECPR provides external circulatory support to patients, helping keep them alive while they are being transported to a hospital.

Capnography & “Cutting the Edge: Innovations in Prehospital Critical Care”

A session, entitled “Cutting the Edge: Innovations in Prehospital Critical Care,” provided an overview of concepts and technologies being implemented for prehospital critical care transports. One such technology is capnography, which is used to monitor respiratory status in patients undergoing transport. It is an especially important monitoring tool for patients who require airway intervention or support; for patients who have been intubated; or for those overdosing on opioids who need naloxone, an opioid reversal drug.

Opioids — the abuse of which is a national epidemic — was even a focus of one of the general sessions, where its impact on public safety and first responders was discussed. Opioids can contribute to respiratory compromise, leading to death. Management of patients overdosing on opioids involves typical prehospital interventions, such as endotracheal intubation, supplemental oxygen administration, upper airway management and patient assessment, among others. Continuous evaluation of ventilation via capnography should also be used to monitor overdosing patients experiencing respiratory compromise. Finally, as naloxone is administered, capnography can also be used to avoid or lessen the chance naloxone triggers violent withdrawal symptoms, by helping with the timing and dosage of naloxone administration. And, even when naloxone is administered, airway management should remain an important consideration for the care of patients overdosing on opioids, as the drugs are often mixed and include other toxins.

NAEMSP & the Respiratory Compromise Institute

NAEMSP’s support of capnography as a life-saving monitoring tool for patients experiencing respiratory compromise in the prehospital or intra-transport hospital setting cannot be overstated. Moreover, as a member society of the Respiratory Compromise Institute (RCI), NAEMSP recognizes the importance of: continued research about the potentially deadly condition; more adoption of best care practices to reduce respiratory compromise’s incidence; and increased awareness and education about the condition as a serious patient safety issue.

RCI and its member societies have and will continue to do great work in bringing attention to respiratory compromise. Together, we can prevent the morbidity and mortality associated with respiratory compromise, regardless of whether patients receive care in the field, during transport or in the hospital.

To learn more about the 2018 NAEMSP annual meeting, see the schedule here: http://www.naemsp.org/Pages/2018-Annual-Meeting-Schedule.aspx

Visit the NAEMSP website for more information on the organization by clicking here: http://www.naemsp.org/Pages/default.aspx

For more information about the 2019 NAEMSP meeting, being held in January in Austin, Texas, click here: http://www.naemsp.org/Pages/Annual-Meeting.aspx                                                                                                                    

Resources

View the RCI’s brochure on Respiratory Compromise

Download the RCI’s presentation at CHEST 2017

Read the latest press release about RCI’s newest member society, the American Association of Nurse Anesthetists, represented by Vanderbilt University Medical Center’s Chief Nurse Anesthetist

See an animation about Respiratory Compromise

About Michael Levy

Michael Levy, MD, FACEP, FACP, FAEMS, serves as the Secretary/Treasurer of NAEMSP. He is currently an Emergency Department Physician at Alaska Regional Hospital in Anchorage, Alaska; the Medical Director for the Anchorage Fire Department; and an Affiliate Associate Professor, UAA College of Health, WWAMI School of Medical Education, University of Alaska Anchorage. Dr. Levy is also an EMS Medical Director for the State of Alaska, as well as the Medical Director for Areawide EMS Anchorage Alaska and the Kenai Peninsula Borough EMS. His EMS experience spans rural, remote, urban, military and medevac-to-urban settings and care scenarios. Dr. Levy is a reviewer for Prehospital Emergency Care, Annals of Emergency Medicine, and Asian EMS Journal. He completed his undergraduate studies in Molecular, Cellular, and Developmental Biology at the University of Colorado Boulder and received his MD from Northwestern University Feinberg School of Medicine. Dr. Levy is board certified in Internal, Emergency Medicine, and EMS Medicine. Among other many other awards, he received the Michael Keys Copass Award in 2017, a national award given annually to an EMS Director who has demonstrated longstanding service and leadership, and has served as a role model for other EMS Directors.

Respiratory Compromise Institute Appoints Brent Dunworth to Clinical Advisory Committee

by Michael Wong

VIENNA, Va., Jan. 31, 2018 /PRNewswire/ — The Respiratory Compromise Institute (RCI) today announced the appointment of Brent Dunworth, DNP, MBA, APRN, CRNA, to its Clinical Advisory Committee. Dr. Dunworth is a member of the American Association of Nurse Anesthetists (AANA), the professional association for more than 52,000 Certified Registered Nurse Anesthetists, and serves as Director of Advanced Practice and Division Chief of Nurse Anesthesia in the Department of Anesthesiology at Vanderbilt University Medical Center (VUMC) in Nashville, Tennessee. He will join a group of thirteen distinguished clinicians who make up the committee, which is dedicated to addressing respiratory compromise across the care continuum via public education, research and advocacy.

Respiratory compromise is a deterioration of respiratory function that poses a high risk of life-threatening respiratory failure. Respiratory failure is the second leading avoidable patient safety issue.1 It is one of the top five conditions leading to increasing hospital costs2 and the third most rapidly increasing hospital inpatient cost in the United States.3 General care floor patients with respiratory compromise are 29 times more likely to die.2

Dr. Dunworth is an educator at the Vanderbilt University School of Nursing and lectures nationally on a variety of nurse anesthesia topics. He has received numerous awards, including: the Agatha Hodgins Award, presented to outstanding nurse anesthesia students; the Pennsylvania Association of Nurse Anesthetists’ Didactic Instructor of the Year Award; and the University of Pittsburgh School of Nursing’s Outstanding Young Alumnus Award. He has given more than 40 presentations on anesthesia-related subjects, such as difficult airway management, anesthesia ventilation, patient safety advocacy in anesthesiology, and problems associated with sleep-disordered breathing. His peer-reviewed publications and abstracts have appeared in AACN Clinical Issues: Advanced Practice in Acute and Critical Care, American Journal of Nursing, AANA Journal and Anesthesia & Analgesia.

“As the Respiratory Compromise Institute continues to grow, we are pleased to have someone on our clinical advisory committee of Dr. Dunworth’s caliber,” said, Phillip Porte, Executive Director of RCI. “We are confident that his nearly 20 years of clinical experience and increasingly responsible leadership at renowned U.S. healthcare centers will enhance our understanding of the impact of anesthesia on respiratory compromise, deepen our advisory talent bench and enrich and expand our research capabilities.”

At VUMC, Dr. Dunworth provides administrative leadership to advanced practice perioperative professionals, including certified registered nurse anesthetists (CRNAs) and certified registered nurse practitioners (CRNPs). His oversight responsibilities include preoperative evaluations, procedural assessments and postoperative recovery monitoring in order to provide safe and efficient patient care delivery. He is responsible for 160 CRNAs, 25 CRNPs and 30 anesthesia technologists. Prior to VUMC, he was Senior Director for Nurse Anesthesia at the University of Pittsburgh Medical Center.

“I am excited to join the Respiratory Compromise Institute’s clinical advisory committee, where I hope my expertise in nurse anesthesia will add to the committee’s already impressive clinical thought leadership,” said Dr. Dunworth. “Practitioners at every level should be well versed in how to recognize and respond to respiratory compromise, which, if identified early, may lower healthcare costs and improve patient outcomes.”

About Respiratory Compromise
Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies).

About Respiratory Compromise Institute
The Respiratory Compromise Institute brings together a broad-based coalition of organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.

References

1 Healthgrades website, “Quality Matters: Tackle the Top 3 Patient Safety Issues.”

2 Kelley SD, SA, Agarwal S, Parikh N, Erslon M, Morris P. Respiratory insufficiency, arrest and failure among medical patients on the general care floor. Crit Care Med. 2012; 40(12):764.

3 NAMDRC, National Association for Medical Direction of Respiratory Care. Reducing respiratory compromise and depression. PR Web. Available at http://www.prweb.com/pdfdownload/12615503.pdf.

https://www.prnewswire.com/news-releases/respiratory-compromise-institute-appoints-brent-dunworth-to-clinical-advisory-committee-300590819.html

For National COPD Awareness Month, Learn How COPD is a Risk Factor for Respiratory Compromise

by Michael Wong

November marks National COPD Awareness Month, an annual observance aimed at increasing public awareness about chronic obstructive pulmonary disease (COPD). By engaging patients, clinicians and respiratory health organizations to communicate about COPD and support awareness events, the observance helps to enhance recognition of and drive education about the disease. One of the member societies of the Respiratory Compromise Institute, the American Association for Respiratory Care, is among the many organizations working to increase awareness about COPD this month.

COPD, a progressive life-threatening lung disease that causes breathlessness, is the third leading cause of death in the United States. Globally, it is estimated that more than three million people died of the disease in 2015, accounting for five percent of all deaths in that year. Not only is COPD itself a life-threatening disease, but it is also a risk factor for respiratory compromise, a potentially lethal condition impacting patients across the care continuum.

Respiratory compromise is a gradual, sometimes subtle imbalance in a person’s breathing response that encompasses respiratory failure and arrest. The condition can occur in nearly any clinical setting, including the home. Patients who undergo anesthesia for medical procedures or recover from surgery may be at particular risk for respiratory compromise, dramatically increasing the likelihood of adverse outcomes and cost of patient care. The condition is a leading patient safety issue and people on the general care floor with respiratory compromise are 29 times more likely to die.

Despite the dangers posed by respiratory compromise, respiratory failure resulting from the condition is potentially avoidable in many cases. For example, detection, mitigation and prevention of respiratory compromise can be aided with the use of patient monitoring technologies, including capnography. Capnography measures exhaled levels of carbon dioxide and is a commonly known, but underutilized, monitoring technology.

Individuals with COPD are just one kind of patient at increased risk of respiratory compromise who may benefit from monitoring with capnography. Older patients are also at risk, as are individuals with obesity, sleep apnea and asthma. -9

For National COPD Awareness Month, speak to those you know with COPD. Talk to them about how they may be at risk for respiratory compromise, that the condition can be prevented, and that addressing it with their healthcare providers is important.

To learn more about respiratory compromise, view the following resources:

Respiratory Compromise Institute Highlights Dangers and Growing Incidence of Respiratory Compromise – a Potentially Deadly Condition – at CHEST 2017

by Michael Wong

VIENNA, VA – October 31, 2017 – The Respiratory Compromise Institute (RCI) was selected to present an update on respiratory compromise — a potentially deadly condition — at CHEST 2017, the annual meeting of the American College of Chest Physicians, taking place in Toronto.

Respiratory compromise is a deterioration of respiratory function that poses a high risk of life-threatening respiratory failure. Respiratory failure is the second leading avoidable patient safety issue.1 It is one of the top five conditions leading to increasing hospital costs2 and the third most rapidly increasing hospital inpatient cost in the United States.3 General care floor patients with respiratory compromise are 29 times more likely to die.2

The plenary workshop presentation, “The Respiratory Compromise Institute and Its Current and Future Research Endeavors,” introduced the RCI to clinicians attending the CHEST meeting. The session also highlighted the latest research on the growing incidence of respiratory compromise through data mined from Medicare claims and delineated future areas for research to better understand how to reduce the incidence of respiratory compromise in both medical and surgical patient populations.

“Our institute is a one-of-a-kind medical society alliance, dedicated to better understanding, raising awareness about and developing strategies to improve the identification and prevention of respiratory compromise, an under-recognized condition with potentially fatal consequences,” said James Lamberti, MD, FCCP, Professor of Medicine, Virginia Commonwealth University School of Medicine, one of the workshop presenters. “My colleagues at the Respiratory Compromise Institute are committed to enhancing the breadth and depth of knowledge about this condition, as well as developing diagnostic and mitigation approaches that drive down the incidence of respiratory compromise and improve health and economic outcomes.”

Additional workshop presenters included: Gerry Criner, MD, FACP, FACCP, Chair and Professor, Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University; Phillip Porte, Executive Director of RCI; Sidney Braman, MD, FCCP, Ichan School of Medicine at Mount Sinai; Neil MacIntyre, MD, FCCP, Duke University Hospital; and Jeffrey Vender, MD, FCCP, Evanston Hospital.

In May at ATS 2017, the annual meeting of the American Thoracic Society, RCI had presented two studies evaluating mortality associated with respiratory compromise in hospitalized Medicare patients. The studies were the first retrospective analyses of mortality associated with respiratory compromise (as measured by respiratory failure) based on Medicare administrative claims data. The findings identified respiratory compromise as a leading cause of mortality in hospitalized Medicare patients.

See an animation about respiratory compromise by visiting: https://www.youtube.com/watch?v=jHZuuEAmDSE

About Respiratory Compromise

Respiratory compromise, which includes respiratory distress, insufficiency, failure and arrest, can occur across numerous clinical scenarios. For example, respiratory compromise may appear post-operatively or may be drug-induced by the delivery of a sedative, opioid, or analgesic to patients who were not properly assessed or properly monitored.

According to the U.S. Department of Health & Human Services, Agency for Healthcare Research and Quality, respiratory compromise is the third most rapidly increasing hospital inpatient cost in the United States, with $7.8 billion spent on respiratory compromise in U.S. hospitals in 2007. Respiratory compromise increases patient mortality rates by over 30 percent and hospital and ICU stays by almost 50 percent. RCI defines respiratory compromise as a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure or death that could be prevented or mitigated through specific interventions (enhanced monitoring and/or therapies).

About Respiratory Compromise Institute

The Respiratory Compromise Institute brings together a broad-based coalition of organizations, companies, and individuals dedicated to reducing—and eventually eliminating—preventable adverse events and deaths due to respiratory compromise.

Medtronic Initiates PRODIGY

by Michael Wong

Medtronic Initiates PRODIGY – a Global Study to Identify Those at High Risk for Opioid Induced Respiratory Depression, a Preventable Form of Respiratory Compromise

Medtronic announced last week the initiation of the PRODIGY study, a prospective, multi-center, post-market, global study to Identify individuals at high risk for opioid induced respiratory depression (OIRD), a form of respiratory compromise.

PRODIGY is an important study as it is the first to assess the clinical and economic benefits of using pulse oximetry and capnography in patients receiving opioid medication on hospital general care floors. Findings from the study will potentially help clinicians determine strategies for earlier detection and prevention of OIRD.

https://globenewswire.com/news-release/2017/05/31/1003946/0/en/Medtronic-Initiates-PRODIGY-a-Global-Study-to-Identify-Those-at-High-Risk-for-Opioid-Induced-Respiratory-Depression-a-Preventable-Form-of-Respiratory-Compromise.html