Preventing respiratory compromise

Preventing respiratory compromise

This article is supported by our partner, Medtronic

First results of landmark PRODIGY study to be presented at a ‘Enhancing Perioperative Patient Safety: PRODIGY First Results’ lunch symposium at Euroanaesthesia on Sunday, June 2 from 12:15-13:45 in the PIANO room.

Four investigators including Prof Wolfgang Buhre (Netherlands), Dr Lucca Brazzi (Italy), Dr Leif Saager (Germany), and Dr Richard Urman (USA) will be sharing important new findings from the multi-center, international prospective ‘PRODIGY’ study (Medtronic-sponsored).

Study results demonstrated that investigators were able to develop an easy-to-use risk prediction tool to identify patients at high risk of developing respiratory compromise, a potentially life-threatening condition causing a progressive inability to breathe adequately. The PRODIGY score identifies adults on the hospital general care floor receiving opioid medication who are at increased risk for opioid-induced respiratory depression (OIRD). Variables used to develop the risk assessment score included age, gender, sleep disorders, chronic heart failure and opioid naïvety. The PRODIGY score performed well, identifying 76 percent of patients with confirmed respiratory depression. Publication of the full results is expected later in 2019.

In addition, results showed that 46% of patients on the general care floor experienced OIRD, which is significantly higher than previously reported in clinical literature. This incidence is accentuated by use of a very strict definition of respiratory depression based on blinded, non-alarming monitoring data. Additionally, all patients experiencing these events were reviewed and confirmed by an independent clinical event committee of physicians.

“Clinical evidence shows that acute and unexpected respiratory compromise on the general care floor is increasingly common. Until now, we have not been successful in predicting which patients are at high risk when recovering on the general care floor,” said Ashish Khanna, M.D., primary study investigator and an associate professor of anesthesiology and intensivist at the Wake Forest University School of Medicine. “These data validate an easy-to-use OIRD risk prediction tool to identify patients at the highest risk and guide early intervention, including continuous monitoring with capnography. Early intervention of these high-risk patients has the potential to improve patient safety and decrease the economic and clinical burden of unplanned ICU admissions.”

The PRODIGY (PRediction of Opioid-induced respiratory Depression In patients monitored by capnoGraphY) study included 1,496 patients across 16 sites in the U.S., Europe and Asia. This is the largest known study using continuous capnography and oximetry. The initial study publication, “Seeking Answers from the PRODIGY Trial,” in the Journal of Critical Care, reviewed respiratory compromise on the general care floor and the study methodology.1 Continuous capnography and pulse oximetry data were collected using Medtronic Microstream™ and NellcorTMmonitoring technology.

The overall question of postoperative OIRD will also be discussed during a late-breaking session with Prof Wolfgang Buhre and Pr Daniela Ionescu (Romania), on Monday, 3 June (15:30 – 16:15 – Flute room).

For additional information about PRODIGY or monitoring for respiratory compromise with capnography in the post-operative and general care settings, please visit