(narcotic-induced respiratory depression)...fio2 0.21 vs 0.5 narcotic-induced respiratory...
TRANSCRIPT
![Page 1: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/1.jpg)
John M Murkin MD, FRCPC, FAI (hon)Dept of Anesthesiology and Perioperative Medicine
Schulich School of MedicineUniversity of Western Ontario
London, OntarioCanada
(Narcotic-Induced Respiratory Depression)
![Page 2: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/2.jpg)
Acknowledgement/Disclosures:
No relevant commercial
affiliations
PSI funded grant 84-41:
(Tissue NIRS in assessment
and management of critically
ill patients )
![Page 3: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/3.jpg)
Water highly absorptive except within range 600-1350 nm “optical window”
Facilitates measurement of key species of HbO2 and oxidative metabolism
Conventional NIRS: 2-4 wavelengths
Broadband NIRS: multi wavelengths
NIR Spectroscopy
BroadbandNIRS
Clinical NIRS
![Page 4: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/4.jpg)
NIRS hemoglobin O2 saturation: differential absorption of various wavelengths between oxygenated and deoxygenated Hemoglobin
Broadband -NIRS
![Page 5: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/5.jpg)
Concerns:malpositionmotion artifactperipheral v/c (cold, ischemia)ambient light
‘alarm fatigue’
‘Change’ in absorptance = arterial saturation
![Page 6: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/6.jpg)
Cerebral NIRS
Treatment algorithm
Sensitive to global ischemic eventsAmenable to physiologic interventions
BUTVariable extracerebral contamination (5-15%)
Analysis algorithm assumes fixed arterial/venouspartitioning (30%/70% - change with ischemia/PaCO2)
Measures very small sample frontal cortex (1cc)
![Page 7: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/7.jpg)
“UT-NIRS detects presence/impairment of cerebral autoregulation””
Cerebral NIRS: new developments-Photo-acoustic coupling
U/S focus beam‘tags’ photons at depthDiscriminates deep cerebral tissue
![Page 8: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/8.jpg)
Broadband-NIRS:Cytochromeaa3 - measurement of energy substrates
Continuous monitoringCBF and CMRO2Detect onset ischemia
![Page 9: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/9.jpg)
Tissue oximetry
![Page 10: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/10.jpg)
▪Initial ICU StO2 strongly correlated
with prolonged ICU admission (>3 d)
▪Serial StO2 trend with prolonged
hospitalization (>10d)
![Page 11: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/11.jpg)
Oxygen supplementation
Narcotic-Induced Respiratory Depression
![Page 12: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/12.jpg)
Δ PaO2
Δ SpO2Δ CaO2/
Decrease in SpO2 is a late indicator of hypoxemia
/
Since ScO2 preserved: SpO2, ScO2, StO2 all decrease late
![Page 13: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/13.jpg)
Alarm
O2 supplementation can delay SpO2 desaturation by several minutes
Hyperoxia decreases peripheral (~80%) and central (~20%) chemoceptor activity (exacerbates apnea since decrease CO2 responsivity)
PaCO2 increases 3-4 mmHg/min (ΔPaCO2 = 10 → ΔpH = 0.08)
4 min → pH ≈ ↓7. 28
Oxygen supplementation
20 healthy volunteers50 ug remifentanilFiO2 0.21 vs 0.5
![Page 14: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/14.jpg)
![Page 15: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/15.jpg)
Narcotic-Induced Respiratory Depression
?
![Page 16: (Narcotic-Induced Respiratory Depression)...FiO2 0.21 vs 0.5 Narcotic-Induced Respiratory Depression? Integrated multimodality monitoring: Ventilation: capnography, impedence plethysmography](https://reader035.vdocuments.us/reader035/viewer/2022063022/5fe9b948458ae7007f298adc/html5/thumbnails/16.jpg)
Integrated multimodality monitoring:
Ventilation: capnography, impedence plethysmography
Oxygenation: SpO2, ScO2,
Hemodynamics: HR,