A new study from Intermountain Health has shown that discharging certain high-risk patients with a pulse oximeter can help prevent opioid-induced respiratory depression at home.
The findings are particularly relevant for ambulatory surgery centers (ASCs), where patients often receive opioids after same-day procedures and then quickly return to their homes without the degree of clinical monitoring they’d receive in other settings.
Home monitoring will likely become a part of an added safety net to post-operative patients in addition to opioid-sparing practices, Dr. Bob Mazzola, principal investigator of the study and enterprise senior medical director for sleep services at Intermountain Health, told Ambulatory Surgery Center News.
“We just had a conversation with our anesthesia colleagues this Monday on how best to incorporate these results into [Intermountain] perioperative care models,” Mazzola said in an email. “The data we obtain will drive further studies and possible interventions into other surgical populations as well as other high-risk populations such as chronic pain patients.”
Intermountain Health is a nonprofit health care system based in Salt Lake City with a range of health care services across Utah, Idaho, Colorado, Montana and Nevada. It has established a reputation of being one of the more innovative systems in the nation.
The study focused on patients undergoing same-day orthopedic surgery who were identified as having specific risk factors, such as signs of sleep apnea or non-adherence to CPAP therapy. Researchers sent these patients home with a monitoring system that measures oxygen saturation and alerts caregivers to low levels that could indicate a respiratory issue.
Caregivers were provided with naloxone and were taught how and when to use it.
The study had 359 subjects who were enrolled and had complete data. Of those, 252 were discharged with supplemental oxygen.
According to the study, 26 patients were prompted to seek emergency treatment after at-home alarms sounded. Among these, 14 were found to have experienced confirmed opioid-related complications. One patient required immediate naloxone administration, and two other patients were similarly identified in the emergency department with serious complications, including a heart attack likely linked to opioid use and acute renal failure.
These events occurred, on average, around 1.8 days post-surgery, which suggests that the typical 24-hour window considered the highest-risk period for opioid-related issues does not fully capture the dangers of respiratory depression at home, researchers wrote.
“We’re often sending patients home with untrained caregivers who might not know what to do or what signs to look for that could indicate opioid induced respiratory depression,” Mazzola said in a press release. “We found that with a simple, commercially available pulse oximeter and monitoring device, we can save lives.”
Many high-risk patients need ongoing monitoring to prevent both fatal outcomes and hypoxic organ damage, which can develop when someone’s oxygen levels remain dangerously low for too long.
“Death due to opioid induced respiratory depression should not be the only concern for high-risk opioid patients prescribed opioids for pain,” Kim Bennion, co-author and research director of respiratory care clinical services at Intermountain Health, said in a press release. “Hypoxic organ damage can also occur and can be identified earlier resulting in more timely intervention. We were able to identify those patients diagnosed in the emergency room with opioid related events and/or opioid induced respiratory depression.”
