Semester

Summer

Date of Graduation

2025

Document Type

Problem/Project Report

Degree Type

DNP

College

School of Nursing

Department

Anesthesiology

Committee Chair

Kellon Smith

Committee Member

Eric Lindstrom

Committee Member

Erin Weekley

Abstract

Abstract

Implementing Noninvasive Capnography Monitoring to Enhance Early Recognition of Postoperative Respiratory Decline in High-Risk Patients: A Quality Improvement Initiative

Trevor Messenger

Background: Those suffering from chronic respiratory disease, obstructive sleep apnea (OSA), obesity, and other serious comorbidities are at an increased risk of respiratory decline after receiving general anesthesia. Respiratory decline leads to adverse outcomes, including increased hospital length of stay, intensive care unit (ICU) admissions, morbidity, and mortality.

Purpose: To improve the safety of postoperative patients at risk for OSA, and to reduce adverse events and airway interventions by enhancing the monitoring capabilities of bedside clinicians with waveform capnography. By providing a more comprehensive vital sign to monitor, clinicians can more rapidly and accurately identify adverse events, leading to more timely and appropriate interventions.

Intervention: Non-invasive capnography monitoring was applied to significantly improve clinicians’ ability to monitor the respiratory status of post-surgical patients and reduce the incidence of postoperative complications such as respiratory decline, hypoxemia, hypoventilation, and unplanned airway interventions.

Project Aims: Evaluate the impact of waveform capnography monitoring, in conjunction with standard vital sign monitoring, on the incidence of hypoventilation, hypoxemia, and airway interventions in the PACU for adult patients who received general anesthesia and have a diagnosis of OSA or a STOP-BANG score of 3 or greater.

Methods: Education of PACU staff on the use of non-invasive ETCO2 monitoring occurred, the implementation of non-invasive ETCO2 monitoring in the PACU was used to monitor identified patients, and data reports were collected from electronic health records to evaluate results. Pre- and post-intervention rates of hypoventilation, hypoxemia, and airway interventions were compared to assess efficacy of implementing non-invasive ETCO2 monitoring in the PACU.

Results: A two-proportion Z-test was conducted to assess differences between the pre- and post-intervention groups regarding incidences of hypopnea/apnea, hypoxemia, and airway interventions. When comparing the pre- and post-intervention groups, for hypopnea/apnea the z-test resulted in a value of 3.8 (p < 0.05). For hypoxemia the z-test proportion was 6.87 (p < 0.05). For airway interventions, the z-test proportion was 3.62 (p < 0.05). These findings imply that applying ETCO2 monitoring to patients at risk for postoperative respiratory events in the PACU will, with a greater than 95% confidence interval, reduce incidences of hypopnea/apnea, hypoxemia, and airway interventions when compared to not applying the monitoring.

When evaluating the average incidence of adverse respiratory events per patient, a significant difference was found between the pre- and post-intervention groups. On average, patients not being monitored with ETCO2 in the PACU will likely experience 1.17 episodes of hypopnea/apnea per patient, 2.1 episodes of hypoxemia per patient, and 0.7 episodes requiring airway intervention per patient. In contrast, on average, patients in the post-intervention group experienced 0.43 episodes of hypopnea/apnea per patient, 1.17 episodes of hypoxemia per patient, and 0.18 episodes requiring an airway intervention per patient. The non-intervention group experienced episodes of hypopnea/apnea 2.72 times more, episodes of hypoxemia 1.79 times more, and episodes of airway interventions 3.89 times more than the ETCO2 group.

Conclusion: Non-invasive ETCO2 monitoring significantly improves the identification of respiratory compromise and thus reduces postoperative pulmonary complications in patients at risk or with a diagnosis of OSA. The use of non-invasive ETCO2 monitoring assists clinicians in more rapidly identifying adverse respiratory events, allowing for timely intervention and prevention of serious adverse outcomes.

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