Clinical Utility of Capnography in the PACU( Post-anaesthesia Care Unit)

Study Overview
=================
Brief Summary
-----------------
Multi-center observational trial with study device blinded in order to assess in parallel standard monitoring and intervention practices related to management of respiratory compromise in the post-anaesthesia care unit (PACU)

Detailed Description
-----------------
All Study device information is blinded to medical staff but the Study Coordinator will have full access to device measurements, alarms, notification and events via a local Wi-Fi hub sent to a portable tablet. The tablet Case Report Form (CRF) will allow all observation be inserted with a time stamp on the electronic device data. In addition, all electronic data will be collected from the bedside monitor.

Official Title
-----------------
A Multi-Center Pilot Observational Trial to Quantify the Potential Clinical Utility of Capnography in the PACU

Conditions
-----------------
Respiratory Depression

Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Adult ≥ 18 years of age ASA Score II - IV (American Society of Anaesthesiologists Score) Patients booked for a surgical procedure requiring general anesthesia care Expected duration of general anesthesia to be > 1.5 hours Expected to receive intraoperative opioids Expected to be transferred to the PACU from the operating room Patients with an expected duration in the PACU ≥ 45 minutes Expected to be transferred from the PACU to an in-patient setting Exclusion Criteria: Patients expected to be discharged from the hospital when discharged from the PACU Subjects who will have oral/nasal surgery that may prevent wearing an oral/nasal capnography sampling filterline. Subjects with a history of severe contact allergies that may cause a reaction to standard adhesive materials found in pulse oximetry sensors. Patients with skin lesions or physical deformities that would prevent the application of finger sensors for optimal performance. A female known to be pregnant.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| AZ PACU<br>Observation of standard of care with capnography blinded | |
| TWH PACU<br>Observation of standard of care with capnography blinded | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of Respiratory Adverse Events in the PACU identified by capnography | Identification by blinded capnography to understand the ventilation challenges of patient in the PACU during standard of care that does not include capnography. First tier is RN (Registered Nurse) level of notification for early intervention and second tier is level at which covering MD (Medical Doctor) might request notification: High Respiration Rate >25 bpm for > 15 seconds (tier one) and >30 bpm for more than 30 seconds (tier two) Low Respiration Rate < 8 bpm for more than 15 seconds and < 6 bpm for more than 30 seconds High end tidal CO2 (EtCO2) > 55 mmHg for > 15 seconds and > 60 mmHg for more than 30 seconds Low EtCO2 < 25 mmHg for > 15 seconds and < 25 mmHg for more than 30 seconds High Heart Rate > 120/min for 15 seconds and >120/min for 30 seconds Low Heart Rate < 40/min for 15 seconds and < 40/min for 30 seconds SpO2 (oxygen saturation by pulse oximetry) /Hypoxemia < 90% for more than 15 seconds and< 90% for more than 30 seconds | Up to 2 hours in the PACU | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Frequency of Critical Adverse Events (CRAE) | Critical CRAE in the PACU or in 24 hour post PACU chart review: Narcotic overdose that required an Opioid reversal Partial airway obstruction that required an NMBA (neuromuscular blocking agent) antagonist Respiratory Insufficiency that would require Non-invasive positive pressure ventilation, ambu bag mask assisted ventilation Respiratory failure that would Invasive mechanical ventilation Upper airway obstruction requiring airway support measures (oral or nasal) such as intubation, LMA (laryngeal mask airway), or airway Respiratory insufficiency/failure that would require a transfer to the ICU Cardiopulmonary arrest Death due to respiratory/pulmonary related complications Other (free text that might capture aspiration, pneumothorax) | PACU and 24 hours post PACU | 
| Ventilation insufficiency on transfer from the PACU | Population of patients leaving the PACU in early stage ventilation respiratory insufficiency as defined as etCO2 ≤ 25 mmHg or etCO2 ≥55 mmHg combined with low RR (respiratory rate) and hypotension within 15 minutes before transport out of the PACU. | At PACU discharge | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Post-operative respiratory distress