A series of presentations from nationally recognized experts included:

Creighton Department of Medicine Grand Rounds – Delirium and Coma in the Pandemic: The COVID-D Study (5/5/21)

Dr. E. Wesley Ely, MD, MPH – Professor of Medicine, Vanderbilt University Medical Center

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)

The Respiratory Compromise Institute and Its Current and Future Research Endeavors

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)
  • James Lamberti, MD, FCCP (Professor of Medicine, Virginia Commonwealth University School of Medicine)
  • Sidney Braman, MD, FCCP (Ichan School of Medicine at Mount Sinai)
  • Neil MacIntyre, MD, FCCP (Duke University Hospital)
  • Jeffrey Vender, MD, FCCP (Evanston Hospital)


  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.