What is Respiratory Compromise?

Respiratory compromise (RC) is defined as a state in which there is a high likelihood of decompensation into respiratory failure or death, but in which continuous monitoring and early intervention might prevent or mitigate decompensation.

What are the etiologies to respiratory compromise?

RC may arise from several different pathways including impaired control of breathing (e.g., opioids), parenchymal lung disease, airway disease, and cardiovascular conditions. Our hypothesis is that these pathways have similar clinical points (e.g., changes in oxygenation and/or ventilation) which can be detected early allowing intervention may mitigate further deterioration.

Can risk of respiratory compromise be assessed?

Many risk factors for RC have been identified in the literature. Generally, these fall into three categories: 1) patient factors (e.g., existing respiratory disease, comorbidities, etc.), 2) iatrogenic factors (e.g., respiratory depressive medications, procedures, etc.), and 3) care setting factors (e.g., nurse to patient ratios, protocols for recognition, etc.). These factors can be assessed with a level of monitoring prescribed commensurate with level of risk.

How might continuous monitoring and early intervention mitigate the cascade into respiratory failure?

Today’s paradigms are focused on rescue rather than prevention. As the severity of RC increases, so too does the complexity of intervention, workflow disruption, need for higher levels of care, costs, and mortality. Concurrently, reversibility of the RC cascade (i.e., prognosis), and the likelihood of favorable outcomes are declining. In certain patient populations at risk for respiratory compromise, continuous monitoring has shown favorable outcomes both clinically and financially (e.g., Dartmouth, Maddox, Fox, etc.).