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Use of the Integrated Pulmonary Index (IPI) to Predict Respiratory Compromise in a Trauma Population
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A5131 - Use of the Integrated Pulmonary Index (IPI) to Predict Respiratory Compromise in a Trauma Population
Author Block: C. Pelaez1, S. K. Spilman2, K. D. Lamb3, T. W. Oetting4, E. A. Fuchsen2, S. D. Olson2, S. M. Sahr5; 1Trauma Surgery, The Iowa Clinic, Des Moines, IA, United States, 2Trauma Services, UnityPoint Health, Des Moines, IA, United States, 3Inova Fairfax Medical Campus, Falls Church, VA, United States, 4Respiratory Therapy, UnityPoint Health, Des Moines, IA, United States, 5Sanford Medical Center, Fargo, ND, United States.
Background: Trauma patients can be at risk for respiratory compromise due to sleep apnea, chest trauma, or analgesia. The Integrated Pulmonary Index (IPI) is a novel approach to monitoring patient physiology using four parameters - end-tidal carbon dioxide, respiratory rate, oxygen saturation, and pulse rate - to provide a numeric indicator of respiratory status. An IPI score of 8-10 indicates a normal range, 5-7 indicates the patient requires attention, and 1-4 indicates need for intervention. The IPI has not been validated in a trauma population. Methods: A prospective feasibility study was conducted at a Level I trauma center in the Midwest. Twenty-two adult trauma patients were approached and 12 patients (55%) consented to participate. Patients were connected to a capnography monitor (Capnostream 20p bedside monitor, Covidien, Boulder, CO) via nasal cannula and fingertip sensor. The alarms were disabled and the screen was covered for blinded monitoring. Data were recorded every 30 seconds, up to a 72 hour maximum. The care team checked on the patient regularly, but IPI data were not used for patient care decisions. Results: The 12 patients averaged 59 years of age (SD=19) and body mass index of 27.6 (SD=5.2). The most common mechanisms of injury were falls (42%) and motor vehicle crashes (25%). There were no deaths, and 58% of patients discharged to skilled nursing or inpatient rehabilitation facilities. There were 521 total hours of monitoring with 62,520 possible data points for each parameter. Valid data were available for 60% of possible measurements. While there were 2748 (8.7%) instances of IPI ≤ 4, there were no adverse events that required intervention from the care team. Conclusions: Monitoring the respiratory status of trauma patients using the IPI was not feasible on an inpatient ward; alarm defaults would have sounded for every out-of-range parameter, including instances when patients removed the nasal cannula or fingertip sensor. The IPI algorithm may be useful in situations where trauma patients are under continuous supervision and/or require moderate to heavy sedation, and we are in the process of incorporating IPI for monitoring these patient populations.
Author Block: C. Pelaez1, S. K. Spilman2, K. D. Lamb3, T. W. Oetting4, E. A. Fuchsen2, S. D. Olson2, S. M. Sahr5; 1Trauma Surgery, The Iowa Clinic, Des Moines, IA, United States, 2Trauma Services, UnityPoint Health, Des Moines, IA, United States, 3Inova Fairfax Medical Campus, Falls Church, VA, United States, 4Respiratory Therapy, UnityPoint Health, Des Moines, IA, United States, 5Sanford Medical Center, Fargo, ND, United States.
Background: Trauma patients can be at risk for respiratory compromise due to sleep apnea, chest trauma, or analgesia. The Integrated Pulmonary Index (IPI) is a novel approach to monitoring patient physiology using four parameters - end-tidal carbon dioxide, respiratory rate, oxygen saturation, and pulse rate - to provide a numeric indicator of respiratory status. An IPI score of 8-10 indicates a normal range, 5-7 indicates the patient requires attention, and 1-4 indicates need for intervention. The IPI has not been validated in a trauma population. Methods: A prospective feasibility study was conducted at a Level I trauma center in the Midwest. Twenty-two adult trauma patients were approached and 12 patients (55%) consented to participate. Patients were connected to a capnography monitor (Capnostream 20p bedside monitor, Covidien, Boulder, CO) via nasal cannula and fingertip sensor. The alarms were disabled and the screen was covered for blinded monitoring. Data were recorded every 30 seconds, up to a 72 hour maximum. The care team checked on the patient regularly, but IPI data were not used for patient care decisions. Results: The 12 patients averaged 59 years of age (SD=19) and body mass index of 27.6 (SD=5.2). The most common mechanisms of injury were falls (42%) and motor vehicle crashes (25%). There were no deaths, and 58% of patients discharged to skilled nursing or inpatient rehabilitation facilities. There were 521 total hours of monitoring with 62,520 possible data points for each parameter. Valid data were available for 60% of possible measurements. While there were 2748 (8.7%) instances of IPI ≤ 4, there were no adverse events that required intervention from the care team. Conclusions: Monitoring the respiratory status of trauma patients using the IPI was not feasible on an inpatient ward; alarm defaults would have sounded for every out-of-range parameter, including instances when patients removed the nasal cannula or fingertip sensor. The IPI algorithm may be useful in situations where trauma patients are under continuous supervision and/or require moderate to heavy sedation, and we are in the process of incorporating IPI for monitoring these patient populations.
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