Postoperative Opioid-induced Respiratory Depression A Closed Claims Analysis
Postoperative Opioid-induced Respiratory Depression A Closed Claims Analysis
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DOI：
10.1097/aln.0000000000000564
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发表时间：
2015-03-01
期刊：
影响因子：
8.8
通讯作者：
Domino, Karen B.
中科院分区：
文献类型：
--
作者：
Lee, Lorri A.;Caplan, Robert A.;Domino, Karen B.
背景：术后阿片类药物引起的呼吸抑制（RD）是围手术期死亡和脑损伤的重要原因。作者检查了与 RD 相关的麻醉封闭式医疗事故索赔，以确定伤害模式是否可以指导预防策略。 方法：从麻醉封闭式索赔项目数据库的 9,799 项索赔中，三位作者使用基于文献的标准回顾了 1990 年至 2009 年间发生的 357 件急性疼痛索赔，以确定 RD 的可能性。之前提到的 RD 患者风险因素、临床管理、护理评估和事件发生时间均从索赔叙述中提取出来，以识别重复出现的模式。 结果：92 项索赔 (= 0.690) 中 RD 被判断为可能、很可能或确定，其中 77% 导致严重脑损伤或死亡。绝大多数 RD 事件 (88%) 发生在手术后 24 小时内，97% 的事件被认为可以通过更好的监测和反应来预防。促成因素和潜在可采取行动的因素包括多个处方者（33%）、同时服用非阿片类镇静药物（34%）以及护理评估或反应不足（31%）。 42% 的索赔中，最后一次护理检查与发现 RD 患者之间的时间间隔在 2 小时内，16% 的索赔间隔在 15 分钟内。事件发生前，62% 的患者出现嗜睡症状。 结论：本次索赔审查支持了越来越多的共识，即阿片类药物相关不良事件是多因素的，并且可以通过改善镇静水平评估、监测氧合和通气以及早期反应和干预（尤其是术后 24 小时内）来预防。
Background: Postoperative opioid-induced respiratory depression (RD) is a significant cause of death and brain damage in the perioperative period. The authors examined anesthesia closed malpractice claims associated with RD to determine whether patterns of injuries could guide preventative strategies.Methods: From the Anesthesia Closed Claims Project database of 9,799 claims, three authors reviewed 357 acute pain claims that occurred between 1990 and 2009 for the likelihood of RD using literature-based criteria. Previously cited patient risk factors for RD, clinical management, nursing assessments, and timing of events were abstracted from claim narratives to identify recurrent patterns.Results: RD was judged as possible, probable, or definite in 92 claims ( = 0.690) of which 77% resulted in severe brain damage or death. The vast majority of RD events (88%) occurred within 24 h of surgery, and 97% were judged as preventable with better monitoring and response. Contributing and potentially actionable factors included multiple prescribers (33%), concurrent administration of nonopioid sedating medications (34%), and inadequate nursing assessments or response (31%). The time between the last nursing check and the discovery of a patient with RD was within 2 h in 42% and within 15 min in 16% of claims. Somnolence was noted in 62% of patients before the event.Conclusions: This claims review supports a growing consensus that opioid-related adverse events are multifactorial and potentially preventable with improvements in assessment of sedation level, monitoring of oxygenation and ventilation, and early response and intervention, particularly within the first 24 h postoperatively.