Prediction of Cardiorespiratory Compromise on Hospital General Care
Units – Are We There Yet?
Ashish Khanna, MD, FCCP, FCCMThe Cleveland Clinic Lerner College of Medicine
October 4, 201812:00 pm – 1:00 pm PDT
Moderator
2
Claire MannehDirector of ProgramsCHPSO, a Division of the Hospital Quality Institute
Housekeeping Items• All lines will be muted. Raise your hand if you wish
to be unmuted.
• A copy of the slides and recording will be available within 1-3 business days
• 1 CE unit will be provided to CHPSO/CHA member hospitals who attend the entire session (12:00 pm -1:00 pm)• Complete the survey by October 11, 2018• CE certs will be emailed within 3-5 business days 3
How to ask a question
4
Today’s Speaker
5
Ashish Khanna, MD, FCCP, FCCMCleveland Clinic Lerner College of Medicine – Staff Intensivist with the Center for
Critical Care– Assistant Professor of Anesthesiology
Prediction of Cardiorespiratory Compromise on Hospital General Care Units – Are We There Yet?
Ashish K. Khanna MD, FCCP, FCCMStaff Intensivist, Surgical ICU & Center for Critical Care
Staff Anesthesiologist, Department of General AnesthesiologyVice-chief for Research, Center for Critical Care
Assistant Professor of Anesthesiology CCLCM, Anesthesiology Institute & Department of Outcomes Research
Cleveland Clinic Foundation, Cleveland, OH,USA
@KhannaAshishCCF
Disclosures
•Medtronic•La Jolla Pharmaceuticals
Objectives
Understand the challenges of predicting cardiorespiratory compromise, and how to address them1
Learn potential benefits of continuous monitoring on the general care floor to improve outcomes2
Identify who to monitor as well as what and how to monitor3
Translate expanded knowledge of cardiorespiratory compromise into improvements in practice and patient monitoring protocols – integrate better in-patient monitoring on the general care floors
4
The Scope of the Problem
Cardiorespiratory complications are the most common cause of 30-day postoperative mortality[4]
Unplanned ICU admissions may have respiratoryindication in 17-47% of cases particularly postoperative pulmonary complications[5-8]
AHRQ rated postoperative respiratory failure as the fourth most common patient safety event[4]
Hypotension and hypoxemia on the general care floor (GCF) is common, profound, prolonged and cannot be reliably predicted [1,2]
49% of cardiac arrest on GCF had a respiratory cause – higher than ICU[3]
AHRQ Quality Indicators - 2015
Indicator Description Numerator Denominator Observed Rate per 1000
PSI #2 Death Rate on Low-Mortality DRG’s 1,822 5,636,509 0.32
PSI #4
PSI #11
PSI # 13
Death Rate among Surgical Inpatients with Serious Treatable Conditions
A: DVTB: PneumoniaC: SepsisD: Cardiac Arrest; shockE: GI Bleed
Postoperative Respiratory Failure
Postoperative Sepsis
22,014
1,2586,1515,6227,7061,277
22,402
4,822
185,587
2,228,418
501,689
118.62
10.05
9.61
0.3- 17% Naloxone hypoventilation hypercarbia SpO2
Anesth Analg 2015 Sep;121(3):709-15.[9]
Desaturation on Surgical WardsMinutes hypoxemia per hour
Blinded ward monitoring
≈850 non-cardiac surgical patients [9]
Hypoxemia episodes of varying duration
90% of episodes during which saturation was
Hypoxemia is common!
SpO2 Duration % of total 10min/hr. 21%20min/hr. 8%5min/hr. 8%
Can we predict post operative hypoxemia?
Post-operative Hypoxemia Common Culprits…
Common Culprits…
• Hypoventilation• Residual narcotics• Residual benzos• Residual inhaled anesthetics• Residual muscle relaxants
• Sleep Disordered Breathing/Obstructive Sleep Apnea
• V/Q mismatch and Shunt
• Atelectasis• Pulmonary edema
• Surgery –Type/Duration ----Pain, splinting, abdominal wall binding, abdominal distension
• Age• Habitus • Type and Duration
of Anesthesia
E.g. surgery type/duration, type and duration of anesthesia, residual narcotics
E.g. Obesity, comorbidities, advanced-age, sleep disordered breathing/
obstructive sleep apnea
E.g. frequency of vital signs checkups
Risk Factors for Cardiorespiratory Compromise
Patient Factors
Treatment Factors
Area of Care Factors
PERFECTSTORM
Saunders R, Ajizian S, Mestek M. Chapter 11: Respiratory Compromise in Moderate and Deep Sedation. Moderate and Deep Sedation in Clinical Practice, Second Edition, ed. Richard D. Urman and Alan D. Kaye. Published by Cambridge University Press. © Cambridge University Press 2017.
[10]
[2]
Incidence Of Patients With An Average Number Of Minutes Per Hour Of Hypoxemia > X During Monitoring
A. SpO2
• Sensitivity Analysis• Time–Weighted SpO2
[2]
Anesth Analg. 2016 Dec;123(6):1471-1479
[11]
• At 95% threshold, at least 10 min/hour of hypoxemia in 79% of patients• At 90% threshold, at least 10 min/hour of hypoxemia in 19% of patients• At 85% threshold, at least 10 min/hour of hypoxemia in 1% of patients
[11]
Can we predict post operative hypoxemia?
If We Cannot Predict It, Can We Monitor It?
•Better monitoring?•Who to monitor?•What to monitor?•How to monitor?
Anesthesiology 2015;122:659-65
[12]
Opioid Induced Respiratory Depression
• 77% death/severe brain damage
• 88% within 24 hr. post-surgery
• 9% STOP-BANG
• Multiple prescribers• Non-opioid sedatives• Inadequate nursing
response
97% preventable – better monitoring and response
42% - 2hr of last check
[12]
Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest.
Overdyk FJ, Dowling O, Marino J, et. al.PLOS ONE 11.2 (2016): e0150214.
Opioids/Sedative Use2007-1012
Cardiac Arrest(n=96,554)
No Cardiac Arrest(n=12,180,137)
Odds Ratio* 95% CI
Both Opioid and Sedative 41.0 % 21.8% 3.47 (3.40, 3.54)
Opioid only 28.0% 31.4% 1.81 (1.77, 1.85)
Sedative only 13.8% 14.3% 1.82 (1.78, 1.87)
Neither Opioid Nor Sedative 17.2% 32.6% Ref.
“Low Acuity” Patients Cardiac Arrest
General Care Floor 21,564
Manually recorded data were, on an average 6.5% higher than those recorded via automated systems!
Anesth Analg 2014;118;326-31
[13]
If we cannot predict it, can we monitor it ??
• Better monitoring? YES• Who to monitor? EVERYONE • What to monitor?• How to monitor? CONTINUOUS (AUTOMATED)
[13]
Pulse Oximetry…• 22,992 participants • No decrease in-hospital mortality• No decrease in-hospital stay• No decrease in transfer to ICU• No decrease in overall mortality
• Potential increased vigilance and decreased pulmonary complications
Can Continuous Monitoring Help?
CPOX – significant improvement in detection
on floorTrend towards less
ICU transfers
Rescue team & Mortality –inconclusive
Capnography –early warning
before desaturation
( O2 supplementation)
Anesthesiology 2017;125:2019-2029
Anesthesiology. 2012;116(2):248-273
Some answers…
• Multimodal analgesia• Improved monitoring and feedback• Continuous capnography • Continuous pulse oximetry • Identify risk factors• Education • Continuous supplemental oxygen
Future Directions??
etCO2 RR SpO2 HR ? Blood Pressure
Improved and smarter monitoring for everyone?
WHAT TO MONITOR? CARDIORESPIRATORY
Available evidence has shown that cardiorespiratory
compromise is common, goes undetected and is largely
unpredictable
HOW TO MONITOR? CONTINUOUS (AUTOMATED)
Continuous monitoring of all patients on the regular floor appears to be the answer to detecting cardiorespiratory
compromise early
WHO TO MONITOR? EVERYONE
APSF recommends continuous monitoring for
all patients receiving opioid therapy in the postoperative
period, especially when supplementary oxygen is
administered
BETTER MONITORING? YES
Continuous monitoring of capnography and oximetry can provide clinicians with
early identification of evolving Respiratory
Compromise, allowing for early intervention that may
prevent tragic consequences
[1,2,14,15]
The RNF – Real time monitoring!
Trending respiratory vital signs [16]
0
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140
160
2/3/06 18:43 2/3/06 18:57 2/3/06 19:12 2/3/06 19:26 2/3/06 19:40 2/3/06 19:55 2/3/06 20:09
HR beats/min
SaO2 %
"Code Blue"
RR breaths/min
ETCO2 mmHg
Continuous capnography/oximetry monitoring during PCA
Chart2
38751.781493055638751.781493055638751.781493055638751.781493055638751.7814930556
38751.782881944438751.782881944438751.782881944438751.782881944438751.7828819444
38751.783576388938751.783576388938751.783576388938751.783576388938751.7835763889
38751.784270833338751.784270833338751.784270833338751.784270833338751.7842708333
38751.784965277838751.784965277838751.784965277838751.784965277838751.7849652778
38751.785659722238751.785659722238751.785659722238751.785659722238751.7856597222
38751.786354166738751.786354166738751.786354166738751.786354166738751.7863541667
38751.787048611138751.787048611138751.787048611138751.787048611138751.7870486111
38751.787743055638751.787743055638751.787743055638751.787743055638751.7877430556
38751.788437538751.788437538751.788437538751.788437538751.7884375
38751.789131944438751.789131944438751.789131944438751.789131944438751.7891319444
38751.789826388938751.789826388938751.789826388938751.789826388938751.7898263889
38751.790520833338751.790520833338751.790520833338751.790520833338751.7905208333
38751.791215277838751.791215277838751.791215277838751.791215277838751.7912152778
38751.791909722238751.791909722238751.791909722238751.791909722238751.7919097222
38751.792604166738751.792604166738751.792604166738751.792604166738751.7926041667
38751.793298611138751.793298611138751.793298611138751.793298611138751.7932986111
38751.793993055638751.793993055638751.793993055638751.793993055638751.7939930556
38751.794687538751.794687538751.794687538751.794687538751.7946875
38751.795381944438751.795381944438751.795381944438751.795381944438751.7953819444
38751.796076388938751.796076388938751.796076388938751.796076388938751.7960763889
38751.796770833338751.796770833338751.796770833338751.796770833338751.7967708333
38751.797465277838751.797465277838751.797465277838751.797465277838751.7974652778
38751.798159722238751.798159722238751.798159722238751.798159722238751.7981597222
38751.798854166738751.798854166738751.798854166738751.798854166738751.7988541667
38751.799548611138751.799548611138751.799548611138751.799548611138751.7995486111
38751.800243055638751.800243055638751.800243055638751.800243055638751.8002430556
38751.800937538751.800937538751.800937538751.800937538751.8009375
38751.801631944438751.801631944438751.801631944438751.801631944438751.8016319444
38751.802326388938751.802326388938751.802326388938751.802326388938751.8023263889
38751.803020833338751.803020833338751.803020833338751.803020833338751.8030208333
38751.803715277838751.803715277838751.803715277838751.803715277838751.8037152778
38751.805127314838751.805127314838751.805127314838751.805127314838751.8051273148
38751.805358796338751.805358796338751.805358796338751.805358796338751.8053587963
38751.805798611138751.805798611138751.805798611138751.805798611138751.8057986111
38751.806481481538751.806481481538751.806481481538751.806481481538751.8064814815
38751.80702546338751.80702546338751.80702546338751.80702546338751.807025463
38751.807881944438751.807881944438751.807881944438751.807881944438751.8078819444
38751.808576388938751.808576388938751.808576388938751.808576388938751.8085763889
38751.809270833338751.809270833338751.809270833338751.809270833338751.8092708333
38751.809965277838751.809965277838751.809965277838751.809965277838751.8099652778
38751.810659722238751.810659722238751.810659722238751.810659722238751.8106597222
38751.811354166738751.811354166738751.811354166738751.811354166738751.8113541667
38751.812048611138751.812048611138751.812048611138751.812048611138751.8120486111
38751.812870370438751.812870370438751.812870370438751.812870370438751.8128703704
38751.813437538751.813437538751.813437538751.813437538751.8134375
38751.814131944438751.814131944438751.814131944438751.814131944438751.8141319444
38751.814826388938751.814826388938751.814826388938751.814826388938751.8148263889
38751.815520833338751.815520833338751.815520833338751.815520833338751.8155208333
38751.816215277838751.816215277838751.816215277838751.816215277838751.8162152778
38751.816770833338751.816770833338751.816770833338751.816770833338751.8167708333
38751.817604166738751.817604166738751.817604166738751.817604166738751.8176041667
38751.818298611138751.818298611138751.818298611138751.818298611138751.8182986111
38751.818993055638751.818993055638751.818993055638751.818993055638751.8189930556
38751.819687538751.819687538751.819687538751.819687538751.8196875
38751.82016203738751.82016203738751.82016203738751.82016203738751.820162037
38751.821076388938751.821076388938751.821076388938751.821076388938751.8210763889
38751.821770833338751.821770833338751.821770833338751.821770833338751.8217708333
38751.822418981538751.822418981538751.822418981538751.822418981538751.8224189815
38751.823159722238751.823159722238751.823159722238751.823159722238751.8231597222
38751.823854166738751.823854166738751.823854166738751.823854166738751.8238541667
38751.824548611138751.824548611138751.824548611138751.824548611138751.8245486111
38751.825682870438751.825682870438751.825682870438751.825682870438751.8256828704
38751.825763888938751.825763888938751.825763888938751.825763888938751.8257638889
38751.826631944438751.826631944438751.826631944438751.826631944438751.8266319444
38751.827326388938751.827326388938751.827326388938751.827326388938751.8273263889
38751.828020833338751.828020833338751.828020833338751.828020833338751.8280208333
38751.828715277838751.828715277838751.828715277838751.828715277838751.8287152778
38751.829409722238751.829409722238751.829409722238751.829409722238751.8294097222
38751.830104166738751.830104166738751.830104166738751.830104166738751.8301041667
38751.830798611138751.830798611138751.830798611138751.830798611138751.8307986111
38751.831493055638751.831493055638751.831493055638751.831493055638751.8314930556
38751.832418981538751.832418981538751.832418981538751.832418981538751.8324189815
38751.832638888938751.832638888938751.832638888938751.832638888938751.8326388889
38751.832881944438751.832881944438751.832881944438751.832881944438751.8328819444
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.834270833338751.834270833338751.834270833338751.834270833338751.8342708333
38751.834965277838751.834965277838751.834965277838751.834965277838751.8349652778
38751.835659722238751.835659722238751.835659722238751.835659722238751.8356597222
38751.836354166738751.836354166738751.836354166738751.836354166738751.8363541667
38751.837048611138751.837048611138751.837048611138751.837048611138751.8370486111
38751.837743055638751.837743055638751.837743055638751.837743055638751.8377430556
HR beats/min
SaO2 %
"Code Blue"
RR breaths/min
ETCO2 mmHg
79
94
28
29
77
93
27
30
76
95
27
30
75
92
26
31
78
95
24
31
83
93
24
28
79
94
26
28
80
94
25
27
82
94
28
28
81
96
27
30
79
94
27
28
83
93
26
27
83
94
27
29
84
92
27
28
82
94
26
27
85
91
28
29
87
90
28
27
83
90
25
30
86
92
28
28
84
93
27
30
85
94
27
24
85
93
26
24
83
90
26
26
82
91
25
23
82
92
27
26
81
94
27
25
85
92
26
27
86
93
29
27
81
94
27
28
75
91
30
27
84
93
29
29
89
93
28
27
92
93
29
28
89
91
32
26
86
90
32
26
90
93
34
25
92
92
34
25
92
93
35
24
90
93
38
26
94
94
39
29
91
94
39
24
94
92
38
26
93
93
38
23
93
90
37
21
96
93
35
24
89
94
38
24
97
93
46
22
98
90
46
24
99
92
42
23
101
94
35
24
98
91
38
26
93
89
36
22
97
89
36
21
86
90
42
21
99
89
44
22
102
88
41
22
103
89
42
21
105
92
37
22
109
91
37
22
100
90
42
22
103
86
45
21
102
87
50
22
116
85
48
19
114
89
44
22
112
84
45
18
115
83
47
16
120
85
48
18
119
84
43
19
117
87
39
21
119
86
43
19
121
88
45
18
124
85
40
17
123
83
37
21
122
83
30
22
119
82
32
19
132
80
123
25
17
132
80
113
25
17
132
80
103
25
17
132
80
93
25
17
132
80
83
25
17
132
80
73
25
17
132
80
63
25
17
132
80
53
25
17
132
80
43
25
17
132
80
33
25
17
132
80
23
25
17
129
77
24
20
133
75
21
19
133
70
23
20
136
74
24
18
132
78
25
24
129
72
26
21
Data a.
PcuDateTimeSaO2 %HR beats/minPCA BolusETCO2 mmHgRR breaths/minCp (MSO4) mcg/cc1/31/06 23:59ModuleAlarmStatusBPM Lower LimitSpO2 Lower LimitMSO4
2/1/06 0:00958840221.629121/31/06 23:598900.1086115
2/1/06 0:01968737211.619102/1/06 0:008900.10794
2/1/06 0:02968239191.609142/1/06 0:018900.10728
2/1/06 0:03968140191.599252/1/06 0:028900.10662
2/1/06 0:049582391.589412/1/06 0:038900.10596
2/1/06 0:05968740171.579642/1/06 0:048900.10531
2/1/06 0:06968541201.571542/1/06 0:058900.10477
2/1/06 0:07958342201.561882/1/06 0:068900.10413
2/1/06 0:08958742221.552282/1/06 0:078900.10349
2/1/06 0:09958443201.542742/1/06 0:088900.10285
2/1/06 0:10968441181.533252/1/06 0:098900.10222
2/1/06 0:11968138191.523832/1/06 0:108900.10159
2/1/06 0:12958340211.516022/1/06 0:118900.10107
2/1/06 0:13958041201.506702/1/06 0:128900.10045
2/1/06 0:14948142201.497442/1/06 0:138900.09983
2/1/06 0:15948343201.488242/1/06 0:148900.09922
2/1/06 0:16938443211.479092/1/06 0:158900.09861
2/1/06 0:17948143191.470002/1/06 0:168900.09800
2/1/06 0:18948142201.462472/1/06 0:168900.09750
2/1/06 0:19938443201.453482/1/06 0:178900.09690
2/1/06 0:20938341171.444552/1/06 0:188900.09630
2/1/06 0:21948239201.435672/1/06 0:198900.09571
2/1/06 0:22948243211.426852/1/06 0:208900.09512
2/1/06 0:23958343171.418082/1/06 0:218900.09454
2/1/06 0:24948243211.410822/1/06 0:228900.09405
2/1/06 0:25968743211.402152/1/06 0:238900.09348
2/1/06 0:26968142171.393542/1/06 0:248900.09290
2/1/06 0:27958243191.384972/1/06 0:258900.09233
2/1/06 0:28948245201.376462/1/06 0:268900.09176
2/1/06 0:29958344201.368012/1/06 0:278900.09120
2/1/06 0:30958242191.361002/1/06 0:288900.09073
2/1/06 0:31958342191.352642/1/06 0:298900.09018
2/1/06 0:32948441201.344332/1/06 0:308900.08962
2/1/06 0:33958741201.336072/1/06 0:318900.08907
2/1/06 0:34968242191.327862/1/06 0:328900.08852
2/1/06 0:35958441181.319712/1/06 0:338900.08798
2/1/06 0:36958342191.312952/1/06 0:348900.08753
2/1/06 0:37958442211.304882/1/06 0:358900.08699
2/1/06 0:38958342211.296872/1/06 0:368900.08646
2/1/06 0:39958340181.288902/1/06 0:378900.08593
2/1/06 0:40958240191.280982/1/06 0:388900.08540
2/1/06 0:41958542201.273112/1/06 0:398900.08487
2/1/06 0:42958442201.266592/1/06 0:408900.08444
2/1/06 0:43968741221.258812/1/06 0:418900.08392
2/1/06 0:44968642181.251082/1/06 0:428900.08341
2/1/06 0:45958542201.243402/1/06 0:438900.08289
2/1/06 0:46948642221.235762/1/06 0:448900.08238
2/1/06 0:47958442201.228172/1/06 0:458900.08188
2/1/06 0:48958541201.221882/1/06 0:468900.08146
2/1/06 0:49978938221.214372/1/06 0:478900.08096
2/1/06 0:50968639201.206922/1/06 0:488900.08046
2/1/06 0:51958640201.199502/1/06 0:498900.07997
2/1/06 0:52948641201.192142/1/06 0:508900.07948
2/1/06 0:53958641201.184812/1/06 0:518900.07899
2/1/06 0:54969041211.178752/1/06 0:518900.07858
2/1/06 0:55958541211.171512/1/06 0:528900.07810
2/1/06 0:56958441191.164312/1/06 0:538900.07762
2/1/06 0:57958340191.157162/1/06 0:548900.07714
2/1/06 0:58948440181.150052/1/06 0:558900.07667
2/1/06 0:59958341201.142992/1/06 0:568900.07620
2/1/06 1:00948542191.137142/1/06 0:578900.07581
2/1/06 1:01958542201.130152/1/06 0:588900.07534
2/1/06 1:02958542211.123212/1/06 0:598900.07488
2/1/06 1:03948642211.116312/1/06 1:008900.07442
2/1/06 1:04958541181.109462/1/06 1:018900.07396
2/1/06 1:05958641211.102642/1/06 1:028900.07351
2/1/06 1:06968841181.097002/1/06 1:038900.07313
2/1/06 1:07948640201.090262/1/06 1:048900.07268
2/1/06 1:08958540201.083572/1/06 1:058900.07224
2/1/06 1:09948640201.076912/1/06 1:068900.07179
2/1/06 1:10938641201.070302/1/06 1:078900.07135
2/1/06 1:11948540191.063722/1/06 1:088900.07091
2/1/06 1:12938838181.058282/1/06 1:098900.07055
2/1/06 1:13958541191.051782/1/06 1:108900.07012
2/1/06 1:14948639221.045322/1/06 1:118900.06969
2/1/06 1:15958638191.038902/1/06 1:128900.06926
2/1/06 1:16958539201.032522/1/06 1:138900.06883
2/1/06 1:17948540201.026182/1/06 1:148900.06841
2/1/06 1:20968637231.020922/1/06 1:158900.06806
2/1/06 1:22958839221.020922/1/06 1:158900.06806
2/1/06 1:24978438211.020922/1/06 1:158900.06806
2/1/06 1:29968837231.020922/1/06 1:158900.06806
2/1/06 1:30958540201.014652/1/06 1:168900.06764
2/1/06 1:31948637201.008422/1/06 1:178900.06723
2/1/06 1:32938639201.002232/1/06 1:188900.06682
2/1/06 1:33938536200.996072/1/06 1:198900.06640
2/1/06 1:34938438200.989962/1/06 1:208900.06600
2/1/06 1:35958540190.984892/1/06 1:218900.06566
2/1/06 1:36938540170.978842/1/06 1:228900.06526
2/1/06 1:37948437180.972832/1/06 1:238900.06486
2/1/06 1:38948439180.966852/1/06 1:248900.06446
2/1/06 1:39938440190.960922/1/06 1:258900.06406
2/1/06 1:40969038200.955022/1/06 1:268900.06367
2/1/06 1:41968639160.950132/1/06 1:268900.06334
2/1/06 1:42948338190.944292/1/06 1:278900.06295
2/1/06 1:43938341200.938492/1/06 1:288900.06257
2/1/06 1:44938341200.932732/1/06 1:298900.06218
2/1/06 1:45928541200.927002/1/06 1:308900.06180
2/1/06 1:46928543190.921312/1/06 1:318900.06142
2/1/06 1:47928742190.916592/1/06 1:328900.06111
2/1/06 1:48928641190.910962/1/06 1:338900.06073
2/1/06 1:49928341190.905372/1/06 1:348900.06036
2/1/06 1:50918140190.899812/1/06 1:358900.05999
2/1/06 1:51928345180.894282/1/06 1:368900.05962
2/1/06 1:52928537200.888792/1/06 1:378900.05925
2/1/06 1:53948537190.884242/1/06 1:388900.05895
2/1/06 1:54928342190.878812/1/06 1:398900.05859
2/1/06 1:559183604220128.017772/1/06 1:408908.53452
2/1/06 1:569284421966.875022/1/06 1:418904.45833
2/1/06 1:579282421936.266862/1/06 1:428902.41779
2/1/06 1:589282422020.901392/1/06 1:438901.39343
2/1/06 1:599285421914.103142/1/06 1:448900.94021
2/1/06 2:00938342209.685332/1/06 1:458900.64569
2/1/06 2:01928542207.401312/1/06 1:468900.49342
2/1/06 2:02918341196.185722/1/06 1:478900.41238
2/1/06 2:03938241185.506692/1/06 1:488900.36711
2/1/06 2:04918342185.098662/1/06 1:498900.33991
2/1/06 2:05928241204.867622/1/06 1:508900.32451
2/1/06 2:064.660752/1/06 1:518900.31072
2/1/06 2:06908342184.496632/1/06 1:528900.29978
2/1/06 2:064.356502/1/06 1:538900.29043
2/1/06 2:07928242204.230872/1/06 1:548900.28206
2/1/06 2:08928342204.114902/1/06 1:558900.27433
2/1/06 2:09928342204.023762/1/06 1:568900.26825
2/1/06 2:10938741213.919752/1/06 1:578900.26132
2/1/06 2:11938240193.820792/1/06 1:588900.25472
2/1/06 2:12928242203.726352/1/06 1:598900.24842
2/1/06 2:13918340193.636072/1/06 2:008900.24240
2/1/06 2:133.549682/1/06 2:018900.23665
2/1/06 2:133.480502/1/06 2:018900.23203
2/1/06 2:14948142193.400692/1/06 2:028900.22671
2/1/06 2:15938341173.324212/1/06 2:038900.22161
2/1/06 2:16928342203.250902/1/06 2:048900.21673
2/1/06 2:17938141193.180602/1/06 2:058900.21204
2/1/06 2:18938243203.113182/1/06 2:068900.20755
2/1/06 2:19928142193.059092/1/06 2:078900.20394
2/1/06 2:20928138202.996582/1/06 2:088900.19977
2/1/06 2:21938140172.936572/1/06 2:098900.19577
2/1/06 2:22938240202.878952/1/06 2:108900.19193
2/1/06 2:23928140192.823602/1/06 2:118900.18824
2/1/06 2:24938342192.770412/1/06 2:128900.18469
2/1/06 2:25938142192.727672/1/06 2:138900.18184
2/1/06 2:252.678192/1/06 2:148900.17855
2/1/06 2:252.630612/1/06 2:158900.17537
2/1/06 2:26948140192.584822/1/06 2:168900.17232
2/1/06 2:27948239192.540752/1/06 2:178900.16938
2/1/06 2:28948037192.498322/1/06 2:188900.16655
2/1/06 2:29938240202.464152/1/06 2:198900.16428
2/1/06 2:30938140192.424522/1/06 2:208900.16163
2/1/06 2:31938741222.386322/1/06 2:218900.15909
2/1/06 2:32968240202.349492/1/06 2:228900.15663
2/1/06 2:33957941182.313962/1/06 2:238900.15426
2/1/06 2:34948042192.279662/1/06 2:248900.15198
2/1/06 2:35947842192.251992/1/06 2:258900.15013
2/1/06 2:36948143172.219832/1/06 2:268900.14799
2/1/06 2:37938242162.188752/1/06 2:278900.14592
2/1/06 2:38948140182.158712/1/06 2:288900.14391
2/1/06 2:39948042182.129652/1/06 2:298900.14198
2/1/06 2:40948042192.101542/1/06 2:308900.14010
2/1/06 2:41937943192.078812/1/06 2:318900.13859
2/1/06 2:42948143192.052322/1/06 2:328900.13682
2/1/06 2:43948143192.026662/1/06 2:338900.13511
2/1/06 2:44938242192.001782/1/06 2:348900.13345
2/1/06 2:45948142191.977672/1/06 2:358900.13184
2/1/06 2:46938142201.954272/1/06 2:368900.13028
2/1/06 2:47948141191.935302/1/06 2:368900.12902
2/1/06 2:48948142191.913142/1/06 2:378900.12754
2/1/06 2:49958340191.891622/1/06 2:388900.12611
2/1/06 2:50978042211.870702/1/06 2:398900.12471
2/1/06 2:51978241211.850372/1/06 2:408900.12336
2/1/06 2:52968041201.830582/1/06 2:418900.12204
2/1/06 2:53968340221.814502/1/06 2:428900.12097
2/1/06 2:54968441231.795672/1/06 2:438900.11971
2/1/06 2:55967942211.777322/1/06 2:448900.11849
2/1/06 2:56957941201.759452/1/06 2:458900.11730
2/1/06 2:57957942201.742022/1/06 2:468900.11613
2/1/06 2:58948241201.725022/1/06 2:478900.11500
2/1/06 2:59948143191.711162/1/06 2:488900.11408
2/1/06 3:00958141191.694902/1/06 2:498900.11299
2/1/06 3:01948143201.679012/1/06 2:508900.11193
2/1/06 3:02958443221.663492/1/06 2:518900.11090
2/1/06 3:03958343211.648322/1/06 2:528900.10989
2/1/06 3:04958144201.633482/1/06 2:538900.10890
2/1/06 3:05947960451990.991832/1/06 2:548906.06612
2/1/06 3:069480441875.102692/1/06 2:558905.00685
2/1/06 3:079481421940.749512/1/06 2:568902.71663
2/1/06 3:089583451923.510322/1/06 2:578901.56735
2/1/06 3:099481431814.816142/1/06 2:588900.98774
2/1/06 3:109483461710.390422/1/06 2:598900.69269
2/1/06 3:11968244198.386272/1/06 3:008900.55908
2/1/06 3:12958044177.032132/1/06 3:018900.46881
2/1/06 3:13947946186.279852/1/06 3:028900.41866
2/1/06 3:14958142195.831262/1/06 3:038900.38875
2/1/06 3:15957945175.537402/1/06 3:048900.36916
2/1/06 3:16947946195.323782/1/06 3:058900.35492
2/1/06 3:17947943205.179492/1/06 3:068900.34530
2/1/06 3:18948144195.029742/1/06 3:078900.33532
2/1/06 3:19958346204.895832/1/06 3:088900.32639
2/1/06 3:20968044214.772332/1/06 3:098900.31816
2/1/06 3:21957942214.656402/1/06 3:108900.31043
2/1/06 3:22957943214.546522/1/06 3:118900.30310
2/1/06 3:23968043214.458942/1/06 3:118900.29726
2/1/06 3:24968442204.358152/1/06 3:128900.29054
2/1/06 3:25967943204.261692/1/06 3:138900.28411
2/1/06 3:26977845164.169292/1/06 3:148900.27795
2/1/06 3:27967844194.080692/1/06 3:158900.27205
2/1/06 3:28967844213.995722/1/06 3:168900.26638
2/1/06 3:29967943203.927542/1/06 3:178900.26184
2/1/06 3:30957844203.848732/1/06 3:188900.25658
2/1/06 3:31957843173.773062/1/06 3:198900.25154
2/1/06 3:32957845193.700372/1/06 3:208900.24669
2/1/06 3:33957945193.630532/1/06 3:218900.24204
2/1/06 3:34967944193.563412/1/06 3:228900.23756
2/1/06 3:35957946193.509452/1/06 3:238900.23396
2/1/06 3:36978544203.446972/1/06 3:248900.22980
2/1/06 3:37968143203.386852/1/06 3:258900.22579
2/1/06 3:38978445183.328992/1/06 3:268900.22193
2/1/06 3:39978043203.273282/1/06 3:278900.21822
2/1/06 3:40967844203.219632/1/06 3:288900.21464
2/1/06 3:41967842203.176412/1/06 3:298900.21176
2/1/06 3:42967744203.126272/1/06 3:308900.20842
2/1/06 3:43958045193.077922/1/06 3:318900.20519
2/1/06 3:44957945193.031282/1/06 3:328900.20209
2/1/06 3:45948045202.986262/1/06 3:338900.19908
2/1/06 3:46958144202.942812/1/06 3:348900.19619
2/1/06 3:47957946182.907732/1/06 3:358900.19385
2/1/06 3:48958046192.866952/1/06 3:368900.19113
2/1/06 3:49958045202.827522/1/06 3:378900.18850
2/1/06 3:50958046202.789392/1/06 3:388900.18596
2/1/06 3:519679604518129.896862/1/06 3:398908.65979
2/1/06 3:529680441968.723782/1/06 3:408904.58159
2/1/06 3:539578451941.844312/1/06 3:418902.78962
2/1/06 3:549579451924.585122/1/06 3:428901.63901
2/1/06 3:559478461815.871732/1/06 3:438901.05812
2/1/06 3:569582452011.427512/1/06 3:448900.76183
2/1/06 3:57967945179.118012/1/06 3:458900.60787
2/1/06 3:58967843187.877802/1/06 3:468900.52519
2/1/06 3:59957945167.268222/1/06 3:468900.48455
2/1/06 4:00947847176.803632/1/06 3:478900.45358
2/1/06 4:01957845196.494352/1/06 3:488900.43296
2/1/06 4:02957947186.265862/1/06 3:498900.41772
2/1/06 4:03957945186.080822/1/06 3:508900.40539
2/1/06 4:04947946155.920432/1/06 3:518900.39470
2/1/06 4:05957845185.798582/1/06 3:528900.38657
2/1/06 4:06948146165.662102/1/06 3:538900.37747
2/1/06 4:07957846175.533632/1/06 3:548900.36891
2/1/06 4:08948045195.411642/1/06 3:558900.36078
2/1/06 4:09958546165.295242/1/06 3:568900.35302
2/1/06 4:10957945175.183862/1/06 3:578900.34559
2/1/06 4:11957943185.094602/1/06 3:588900.33964
2/1/06 4:12957944194.991522/1/06 3:598900.33277
2/1/06 4:13948045174.892592/1/06 4:008900.32617
2/1/06 4:14957946174.797592/1/06 4:018900.31984
2/1/06 4:15948145174.706332/1/06 4:028900.31376
2/1/06 4:16978244184.618632/1/06 4:038900.30791
2/1/06 4:17948047184.548142/1/06 4:048900.30321
2/1/06 4:18957845174.466542/1/06 4:058900.29777
2/1/06 4:19957546174.388032/1/06 4:068900.29254
2/1/06 4:20947747164.312482/1/06 4:078900.28750
2/1/06 4:21947847144.239752/1/06 4:088900.28265
2/1/06 4:22957846154.169712/1/06 4:098900.27798
2/1/06 4:23957748164.113302/1/06 4:108900.27422
2/1/06 4:24957747154.047872/1/06 4:118900.26986
2/1/06 4:25957546173.984782/1/06 4:128900.26565
2/1/06 4:26947845173.923932/1/06 4:138900.26160
2/1/06 4:27967946153.865222/1/06 4:148900.25768
2/1/06 4:28978044163.808552/1/06 4:158900.25390
2/1/06 4:29967746173.762812/1/06 4:168900.25085
2/1/06 4:30957645163.709632/1/06 4:178900.24731
2/1/06 4:31957845173.658232/1/06 4:188900.24388
2/1/06 4:32947747163.608542/1/06 4:198900.24057
2/1/06 4:33957747153.560472/1/06 4:208900.23736
2/1/06 4:34957647143.513952/1/06 4:218900.23426
2/1/06 4:35947749163.476322/1/06 4:218900.23175
2/1/06 4:36957646153.432462/1/06 4:228900.22883
2/1/06 4:37947747163.389962/1/06 4:238900.22600
2/1/06 4:38947747173.348762/1/06 4:248900.22325
2/1/06 4:39947749143.308812/1/06 4:258900.22059
2/1/06 4:40937748153.270032/1/06 4:268900.21800
2/1/06 4:41937846163.238592/1/06 4:278900.21591
2/1/06 4:42987943153.201852/1/06 4:288900.21346
2/1/06 4:43977644143.166162/1/06 4:298900.21108
2/1/06 4:44977647133.131462/1/06 4:308900.20876
2/1/06 4:45957648163.097712/1/06 4:318900.20651
2/1/06 4:46947748133.064882/1/06 4:328900.20433
2/1/06 4:47937647143.038182/1/06 4:338900.20255
2/1/06 4:48947750123.006912/1/06 4:348900.20046
2/1/06 4:49957548102.976452/1/06 4:358900.19843
2/1/06 4:50957648112.946752/1/06 4:368900.19645
2/1/06 4:51937547132.917792/1/06 4:378900.19452
2/1/06 4:52957648112.889532/1/06 4:388900.19264
2/1/06 4:53947650142.866502/1/06 4:398900.19110
2/1/06 4:54957649132.839462/1/06 4:408900.18930
2/1/06 4:55947548112.813042/1/06 4:418900.18754
2/1/06 4:5696774892.787222/1/06 4:428900.18581
2/1/06 4:57967747102.761972/1/06 4:438900.18413
2/1/06 4:58947748112.737272/1/06 4:448900.18248
data b.
PcuDateTimeHR beats/minSaO2 %"Code Blue"RR breaths/minETCO2 mmHgPulseAverageBPM Lower LimitSpO2 Lower LimitAlarm EtCO2/BPM48265050
2/3/06 18:4579942829
2/3/06 18:4777932730890
2/3/06 18:4876952730890
2/3/06 18:4975922631890
2/3/06 18:5078952431890
2/3/06 18:5183932428890
2/3/06 18:5279942628890
2/3/06 18:5380942527890
2/3/06 18:5482942828890
2/3/06 18:5581962730890
2/3/06 18:5679942728890
2/3/06 18:5783932627890
2/3/06 18:5883942729890
2/3/06 18:5984922728890
2/3/06 19:0082942627890
2/3/06 19:0185912829890
2/3/06 19:0287902827890
2/3/06 19:0383902530890
2/3/06 19:0486922828890
2/3/06 19:0584932730890
2/3/06 19:0685942724890
2/3/06 19:0785932624890
2/3/06 19:0883902626890
2/3/06 19:0982912523890
2/3/06 19:1082922726890
2/3/06 19:1181942725890
2/3/06 19:1285922627890
2/3/06 19:1386932927890
2/3/06 19:1481942728890
2/3/06 19:1575913027890
2/3/06 19:1684932929890
2/3/06 19:1789932827890
2/3/06 19:1992932928890
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Figure 5a.
Fig 5. Monitor Trend data: a. Opioid induced respiratory depression b. Aspiration peumonia
Figure 5a.
38749.000046296338749.000046296338749.000046296338749.000046296338749.0000462963
38749.000740740738749.000740740738749.000740740738749.000740740738749.0007407407
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38749.002129629638749.002129629638749.002129629638749.002129629638749.0021296296
38749.002824074138749.002824074138749.002824074138749.002824074138749.0028240741
38749.003518518538749.003518518538749.003518518538749.003518518538749.0035185185
38749.00421296338749.00421296338749.00421296338749.00421296338749.004212963
38749.004907407438749.004907407438749.004907407438749.004907407438749.0049074074
38749.005601851938749.005601851938749.005601851938749.005601851938749.0056018519
38749.006296296338749.006296296338749.006296296338749.006296296338749.0062962963
38749.006990740738749.006990740738749.006990740738749.006990740738749.0069907407
38749.007685185238749.007685185238749.007685185238749.007685185238749.0076851852
38749.008379629638749.008379629638749.008379629638749.008379629638749.0083796296
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38749.009768518538749.009768518538749.009768518538749.009768518538749.0097685185
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38749.013935185238749.013935185238749.013935185238749.013935185238749.0139351852
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38749.015324074138749.015324074138749.015324074138749.015324074138749.0153240741
38749.016018518538749.016018518538749.016018518538749.016018518538749.0160185185
38749.01671296338749.01671296338749.01671296338749.01671296338749.016712963
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38749.018796296338749.018796296338749.018796296338749.018796296338749.0187962963
38749.019490740738749.019490740738749.019490740738749.019490740738749.0194907407
38749.020185185238749.020185185238749.020185185238749.020185185238749.0201851852
38749.020879629638749.020879629638749.020879629638749.020879629638749.0208796296
38749.021574074138749.021574074138749.021574074138749.021574074138749.0215740741
38749.022268518538749.022268518538749.022268518538749.022268518538749.0222685185
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38749.025740740738749.025740740738749.025740740738749.025740740738749.0257407407
38749.026435185238749.026435185238749.026435185238749.026435185238749.0264351852
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38749.034768518538749.034768518538749.034768518538749.034768518538749.0347685185
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38749.038935185238749.038935185238749.038935185238749.038935185238749.0389351852
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38749.043796296338749.043796296338749.043796296338749.043796296338749.0437962963
38749.044490740738749.044490740738749.044490740738749.044490740738749.0444907407
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38749.056990740738749.056990740738749.056990740738749.056990740738749.0569907407
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38749.071574074138749.071574074138749.071574074138749.071574074138749.0715740741
38749.072268518538749.072268518538749.072268518538749.072268518538749.0722685185
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38749.073657407438749.073657407438749.073657407438749.073657407438749.0736574074
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38749.080601851838749.080601851838749.080601851838749.080601851838749.0806018518
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38749.087538749.087538749.087538749.087538749.0875
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38749.103518518538749.103518518538749.103518518538749.103518518538749.1035185185
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38749.105601851938749.105601851938749.105601851938749.105601851938749.1056018519
38749.106296296338749.106296296338749.106296296338749.106296296338749.1062962963
38749.106990740738749.106990740738749.106990740738749.106990740738749.1069907407
38749.107685185238749.107685185238749.107685185238749.107685185238749.1076851852
38749.108379629638749.108379629638749.108379629638749.108379629638749.1083796296
38749.109074074138749.109074074138749.109074074138749.109074074138749.1090740741
38749.109768518538749.109768518538749.109768518538749.109768518538749.1097685185
38749.11046296338749.11046296338749.11046296338749.11046296338749.110462963
38749.111157407438749.111157407438749.111157407438749.111157407438749.1111574074
38749.111851851838749.111851851838749.111851851838749.111851851838749.1118518518
38749.112546296338749.112546296338749.112546296338749.112546296338749.1125462963
38749.113240740738749.113240740738749.113240740738749.113240740738749.1132407407
38749.113935185238749.113935185238749.113935185238749.113935185238749.1139351852
38749.114629629638749.114629629638749.114629629638749.114629629638749.1146296296
38749.115324074138749.115324074138749.115324074138749.115324074138749.1153240741
38749.116018518538749.116018518538749.116018518538749.116018518538749.1160185185
38749.11671296338749.11671296338749.11671296338749.11671296338749.116712963
38749.117407407438749.117407407438749.117407407438749.117407407438749.1174074074
38749.118101851938749.118101851938749.118101851938749.118101851938749.1181018519
38749.118796296338749.118796296338749.118796296338749.118796296338749.1187962963
38749.119490740738749.119490740738749.119490740738749.119490740738749.1194907407
38749.120185185238749.120185185238749.120185185238749.120185185238749.1201851852
38749.120879629638749.120879629638749.120879629638749.120879629638749.1208796296
38749.121574074138749.121574074138749.121574074138749.121574074138749.1215740741
38749.122268518538749.122268518538749.122268518538749.122268518538749.1222685185
38749.12296296338749.12296296338749.12296296338749.12296296338749.122962963
38749.123657407438749.123657407438749.123657407438749.123657407438749.1236574074
38749.124351851938749.124351851938749.124351851938749.124351851938749.1243518519
38749.125046296338749.125046296338749.125046296338749.125046296338749.1250462963
38749.125740740738749.125740740738749.125740740738749.125740740738749.1257407407
38749.126435185238749.126435185238749.126435185238749.126435185238749.1264351852
38749.127129629638749.127129629638749.127129629638749.127129629638749.1271296296
38749.127824074138749.127824074138749.127824074138749.127824074138749.1278240741
38749.128518518538749.128518518538749.128518518538749.128518518538749.1285185185
38749.12921296338749.12921296338749.12921296338749.12921296338749.129212963
38749.129907407438749.129907407438749.129907407438749.129907407438749.1299074074
38749.130601851938749.130601851938749.130601851938749.130601851938749.1306018519
38749.131296296338749.131296296338749.131296296338749.131296296338749.1312962963
38749.131990740738749.131990740738749.131990740738749.131990740738749.1319907407
38749.132685185238749.132685185238749.132685185238749.132685185238749.1326851852
38749.133379629638749.133379629638749.133379629638749.133379629638749.1333796296
38749.134074074138749.134074074138749.134074074138749.134074074138749.1340740741
38749.134768518538749.134768518538749.134768518538749.134768518538749.1347685185
38749.13546296338749.13546296338749.13546296338749.13546296338749.135462963
38749.136157407438749.136157407438749.136157407438749.136157407438749.1361574074
38749.136851851938749.136851851938749.136851851938749.136851851938749.1368518519
38749.137546296338749.137546296338749.137546296338749.137546296338749.1375462963
38749.138240740738749.138240740738749.138240740738749.138240740738749.1382407407
38749.138935185238749.138935185238749.138935185238749.138935185238749.1389351852
38749.139629629638749.139629629638749.139629629638749.139629629638749.1396296296
38749.140324074138749.140324074138749.140324074138749.140324074138749.1403240741
38749.141018518538749.141018518538749.141018518538749.141018518538749.1410185185
38749.14171296338749.14171296338749.14171296338749.14171296338749.141712963
38749.142407407438749.142407407438749.142407407438749.142407407438749.1424074074
38749.143101851838749.143101851838749.143101851838749.143101851838749.1431018518
38749.143796296338749.143796296338749.143796296338749.143796296338749.1437962963
38749.144490740738749.144490740738749.144490740738749.144490740738749.1444907407
38749.145185185238749.145185185238749.145185185238749.145185185238749.1451851852
38749.145879629638749.145879629638749.145879629638749.145879629638749.1458796296
38749.146574074138749.146574074138749.146574074138749.146574074138749.1465740741
38749.147268518538749.147268518538749.147268518538749.147268518538749.1472685185
38749.14796296338749.14796296338749.14796296338749.14796296338749.147962963
38749.148657407438749.148657407438749.148657407438749.148657407438749.1486574074
38749.149351851938749.149351851938749.149351851938749.149351851938749.1493518519
38749.150046296338749.150046296338749.150046296338749.150046296338749.1500462963
38749.150740740738749.150740740738749.150740740738749.150740740738749.1507407407
38749.151435185238749.151435185238749.151435185238749.151435185238749.1514351852
38749.152129629638749.152129629638749.152129629638749.152129629638749.1521296296
38749.152824074138749.152824074138749.152824074138749.152824074138749.1528240741
38749.153518518538749.153518518538749.153518518538749.153518518538749.1535185185
38749.15421296338749.15421296338749.15421296338749.15421296338749.154212963
38749.154907407438749.154907407438749.154907407438749.154907407438749.1549074074
38749.155601851938749.155601851938749.155601851938749.155601851938749.1556018519
38749.156296296338749.156296296338749.156296296338749.156296296338749.1562962963
38749.156990740738749.156990740738749.156990740738749.156990740738749.1569907407
38749.157685185238749.157685185238749.157685185238749.157685185238749.1576851852
38749.158379629638749.158379629638749.158379629638749.158379629638749.1583796296
38749.159074074138749.159074074138749.159074074138749.159074074138749.1590740741
38749.159768518538749.159768518538749.159768518538749.159768518538749.1597685185
38749.16046296338749.16046296338749.16046296338749.16046296338749.160462963
38749.161157407438749.161157407438749.161157407438749.161157407438749.1611574074
38749.161851851938749.161851851938749.161851851938749.161851851938749.1618518519
38749.162546296338749.162546296338749.162546296338749.162546296338749.1625462963
38749.163240740738749.163240740738749.163240740738749.163240740738749.1632407407
38749.163935185238749.163935185238749.163935185238749.163935185238749.1639351852
38749.164629629638749.164629629638749.164629629638749.164629629638749.1646296296
38749.165324074138749.165324074138749.165324074138749.165324074138749.1653240741
38749.166018518538749.166018518538749.166018518538749.166018518538749.1660185185
38749.16671296338749.16671296338749.16671296338749.16671296338749.166712963
38749.167407407438749.167407407438749.167407407438749.167407407438749.1674074074
38749.168101851938749.168101851938749.168101851938749.168101851938749.1681018519
38749.168796296338749.168796296338749.168796296338749.168796296338749.1687962963
38749.169490740738749.169490740738749.169490740738749.169490740738749.1694907407
38749.170185185238749.170185185238749.170185185238749.170185185238749.1701851852
38749.170879629638749.170879629638749.170879629638749.170879629638749.1708796296
38749.171574074138749.171574074138749.171574074138749.171574074138749.1715740741
38749.172268518538749.172268518538749.172268518538749.172268518538749.1722685185
38749.17296296338749.17296296338749.17296296338749.17296296338749.172962963
38749.173657407438749.173657407438749.173657407438749.173657407438749.1736574074
38749.174351851838749.174351851838749.174351851838749.174351851838749.1743518518
38749.175046296338749.175046296338749.175046296338749.175046296338749.1750462963
38749.175740740738749.175740740738749.175740740738749.175740740738749.1757407407
38749.176435185238749.176435185238749.176435185238749.176435185238749.1764351852
38749.177129629638749.177129629638749.177129629638749.177129629638749.1771296296
38749.177824074138749.177824074138749.177824074138749.177824074138749.1778240741
38749.178518518538749.178518518538749.178518518538749.178518518538749.1785185185
38749.17921296338749.17921296338749.17921296338749.17921296338749.179212963
38749.179907407438749.179907407438749.179907407438749.179907407438749.1799074074
38749.180601851938749.180601851938749.180601851938749.180601851938749.1806018519
38749.181296296338749.181296296338749.181296296338749.181296296338749.1812962963
38749.181990740738749.181990740738749.181990740738749.181990740738749.1819907407
38749.182685185238749.182685185238749.182685185238749.182685185238749.1826851852
38749.183379629638749.183379629638749.183379629638749.183379629638749.1833796296
38749.184074074138749.184074074138749.184074074138749.184074074138749.1840740741
38749.184768518538749.184768518538749.184768518538749.184768518538749.1847685185
38749.18546296338749.18546296338749.18546296338749.18546296338749.185462963
38749.186157407438749.186157407438749.186157407438749.186157407438749.1861574074
38749.186851851938749.186851851938749.186851851938749.186851851938749.1868518519
38749.187546296338749.187546296338749.187546296338749.187546296338749.1875462963
38749.188240740738749.188240740738749.188240740738749.188240740738749.1882407407
38749.188935185238749.188935185238749.188935185238749.188935185238749.1889351852
38749.189629629638749.189629629638749.189629629638749.189629629638749.1896296296
38749.190324074138749.190324074138749.190324074138749.190324074138749.1903240741
38749.191018518538749.191018518538749.191018518538749.191018518538749.1910185185
38749.19171296338749.19171296338749.19171296338749.19171296338749.191712963
38749.192407407438749.192407407438749.192407407438749.192407407438749.1924074074
38749.193101851938749.193101851938749.193101851938749.193101851938749.1931018519
38749.193796296338749.193796296338749.193796296338749.193796296338749.1937962963
38749.194490740738749.194490740738749.194490740738749.194490740738749.1944907407
38749.195185185238749.195185185238749.195185185238749.195185185238749.1951851852
38749.195879629638749.195879629638749.195879629638749.195879629638749.1958796296
38749.196574074138749.196574074138749.196574074138749.196574074138749.1965740741
38749.197268518538749.197268518538749.197268518538749.197268518538749.1972685185
38749.19796296338749.19796296338749.19796296338749.19796296338749.197962963
38749.198657407438749.198657407438749.198657407438749.198657407438749.1986574074
38749.199351851938749.199351851938749.199351851938749.199351851938749.1993518519
38749.200046296338749.200046296338749.200046296338749.200046296338749.2000462963
38749.200740740738749.200740740738749.200740740738749.200740740738749.2007407407
38749.201435185238749.201435185238749.201435185238749.201435185238749.2014351852
38749.202129629638749.202129629638749.202129629638749.202129629638749.2021296296
38749.202824074138749.202824074138749.202824074138749.202824074138749.2028240741
38749.203518518538749.203518518538749.203518518538749.203518518538749.2035185185
38749.20421296338749.20421296338749.20421296338749.20421296338749.204212963
38749.204907407438749.204907407438749.204907407438749.204907407438749.2049074074
38749.205601851838749.205601851838749.205601851838749.205601851838749.2056018518
38749.206296296338749.206296296338749.206296296338749.206296296338749.2062962963
38749.206990740738749.206990740738749.206990740738749.206990740738749.2069907407
SaO2 %
HR beats/min
PCA Bolus
ETCO2 mmHg
RR breaths/min
95
88
40
22
96
87
37
21
96
82
39
19
96
81
40
19
95
82
39
96
87
40
17
96
85
41
20
95
83
42
20
95
87
42
22
95
84
43
20
96
84
41
18
96
81
38
19
95
83
40
21
95
80
41
20
94
81
42
20
94
83
43
20
93
84
43
21
94
81
43
19
94
81
42
20
93
84
43
20
93
83
41
17
94
82
39
20
94
82
43
21
95
83
43
17
94
82
43
21
96
87
43
21
96
81
42
17
95
82
43
19
94
82
45
20
95
83
44
20
95
82
42
19
95
83
42
19
94
84
41
20
95
87
41
20
96
82
42
19
95
84
41
18
95
83
42
19
95
84
42
21
95
83
42
21
95
83
40
18
95
82
40
19
95
85
42
20
95
84
42
20
96
87
41
22
96
86
42
18
95
85
42
20
94
86
42
22
95
84
42
20
95
85
41
20
97
89
38
22
96
86
39
20
95
86
40
20
94
86
41
20
95
86
41
20
96
90
41
21
95
85
41
21
95
84
41
19
95
83
40
19
94
84
40
18
95
83
41
20
94
85
42
19
95
85
42
20
95
85
42
21
94
86
42
21
95
85
41
18
95
86
41
21
96
88
41
18
94
86
40
20
95
85
40
20
94
86
40
20
93
86
41
20
94
85
40
19
93
88
38
18
95
85
41
19
94
86
39
22
95
86
38
19
95
85
39
20
94
85
40
20
96
86
37
23
95
88
39
22
97
84
38
21
96
88
37
23
95
85
40
20
94
86
37
20
93
86
39
20
93
85
36
20
93
84
38
20
95
85
40
19
93
85
40
17
94
84
37
18
94
84
39
18
93
84
40
19
96
90
38
20
96
86
39
16
94
83
38
19
93
83
41
20
93
83
41
20
92
85
41
20
92
85
43
19
92
87
42
19
92
86
41
19
92
83
41
19
91
81
40
19
92
83
45
18
92
85
37
20
94
85
37
19
92
83
42
19
91
83
60
42
20
92
84
42
19
92
82
42
19
92
82
42
20
92
85
42
19
93
83
42
20
92
85
42
20
91
83
41
19
93
82
41
18
91
83
42
18
92
82
41
20
90
83
42
18
92
82
42
20
92
83
42
20
92
83
42
20
93
87
41
21
93
82
40
19
92
82
42
20
91
83
40
19
94
81
42
19
93
83
41
17
92
83
42
20
93
81
41
19
93
82
43
20
92
81
42
19
92
81
38
20
93
81
40
17
93
82
40
20
92
81
40
19
93
83
42
19
93
81
42
19
94
81
40
19
94
82
39
19
94
80
37
19
93
82
40
20
93
81
40
19
93
87
41
22
96
82
40
20
95
79
41
18
94
80
42
19
94
78
42
19
94
81
43
17
93
82
42
16
94
81
40
18
94
80
42
18
94
80
42
19
93
79
43
19
94
81
43
19
94
81
43
19
93
82
42
19
94
81
42
19
93
81
42
20
94
81
41
19
94
81
42
19
95
83
40
19
97
80
42
21
97
82
41
21
96
80
41
20
96
83
40
22
96
84
41
23
96
79
42
21
95
79
41
20
95
79
42
20
94
82
41
20
94
81
43
19
95
81
41
19
94
81
43
20
95
84
43
22
95
83
43
21
95
81
44
20
94
79
60
45
19
94
80
44
18
94
81
42
19
95
83
45
19
94
81
43
18
94
83
46
17
96
82
44
19
95
80
44
17
94
79
46
18
95
81
42
19
95
79
45
17
94
79
46
19
94
79
43
20
94
81
44
19
95
83
46
20
96
80
44
21
95
79
42
21
95
79
43
21
96
80
43
21
96
84
42
20
96
79
43
20
97
78
45
16
96
78
44
19
96
78
44
21
96
79
43
20
95
78
44
20
95
78
43
17
95
78
45
19
95
79
45
19
96
79
44
19
95
79
46
19
97
85
44
20
96
81
43
20
97
84
45
18
97
80
43
20
96
78
44
20
96
78
42
20
96
77
44
20
95
80
45
19
95
79
45
19
94
80
45
20
95
81
44
20
95
79
46
18
95
80
46
19
95
80
45
20
95
80
46
20
96
79
60
45
18
96
80
44
19
95
78
45
19
95
79
45
19
94
78
46
18
95
82
45
20
96
79
45
17
96
78
43
18
95
79
45
16
94
78
47
17
95
78
45
19
95
79
47
18
95
79
45
18
94
79
46
15
95
78
45
18
94
81
46
16
95
78
46
17
94
80
45
19
95
85
46
16
95
79
45
17
95
79
43
18
95
79
44
19
94
80
45
17
95
79
46
17
94
81
45
17
97
82
44
18
94
80
47
18
95
78
45
17
95
75
46
17
94
77
47
16
94
78
47
14
95
78
46
15
95
77
48
16
95
77
47
15
95
75
46
17
94
78
45
17
96
79
46
15
97
80
44
16
96
77
46
17
95
76
45
16
95
78
45
17
94
77
47
16
95
77
47
15
95
76
47
14
94
77
49
16
95
76
46
15
94
77
47
16
94
77
47
17
94
77
49
14
93
77
48
15
93
78
46
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93
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50
12
95
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11
Figure 5b.
Figure 5b.
38751.781493055638751.781493055638751.781493055638751.781493055638751.7814930556
38751.782881944438751.782881944438751.782881944438751.782881944438751.7828819444
38751.783576388938751.783576388938751.783576388938751.783576388938751.7835763889
38751.784270833338751.784270833338751.784270833338751.784270833338751.7842708333
38751.784965277838751.784965277838751.784965277838751.784965277838751.7849652778
38751.785659722238751.785659722238751.785659722238751.785659722238751.7856597222
38751.786354166738751.786354166738751.786354166738751.786354166738751.7863541667
38751.787048611138751.787048611138751.787048611138751.787048611138751.7870486111
38751.787743055638751.787743055638751.787743055638751.787743055638751.7877430556
38751.788437538751.788437538751.788437538751.788437538751.7884375
38751.789131944438751.789131944438751.789131944438751.789131944438751.7891319444
38751.789826388938751.789826388938751.789826388938751.789826388938751.7898263889
38751.790520833338751.790520833338751.790520833338751.790520833338751.7905208333
38751.791215277838751.791215277838751.791215277838751.791215277838751.7912152778
38751.791909722238751.791909722238751.791909722238751.791909722238751.7919097222
38751.792604166738751.792604166738751.792604166738751.792604166738751.7926041667
38751.793298611138751.793298611138751.793298611138751.793298611138751.7932986111
38751.793993055638751.793993055638751.793993055638751.793993055638751.7939930556
38751.794687538751.794687538751.794687538751.794687538751.7946875
38751.795381944438751.795381944438751.795381944438751.795381944438751.7953819444
38751.796076388938751.796076388938751.796076388938751.796076388938751.7960763889
38751.796770833338751.796770833338751.796770833338751.796770833338751.7967708333
38751.797465277838751.797465277838751.797465277838751.797465277838751.7974652778
38751.798159722238751.798159722238751.798159722238751.798159722238751.7981597222
38751.798854166738751.798854166738751.798854166738751.798854166738751.7988541667
38751.799548611138751.799548611138751.799548611138751.799548611138751.7995486111
38751.800243055638751.800243055638751.800243055638751.800243055638751.8002430556
38751.800937538751.800937538751.800937538751.800937538751.8009375
38751.801631944438751.801631944438751.801631944438751.801631944438751.8016319444
38751.802326388938751.802326388938751.802326388938751.802326388938751.8023263889
38751.803020833338751.803020833338751.803020833338751.803020833338751.8030208333
38751.803715277838751.803715277838751.803715277838751.803715277838751.8037152778
38751.805127314838751.805127314838751.805127314838751.805127314838751.8051273148
38751.805358796338751.805358796338751.805358796338751.805358796338751.8053587963
38751.805798611138751.805798611138751.805798611138751.805798611138751.8057986111
38751.806481481538751.806481481538751.806481481538751.806481481538751.8064814815
38751.80702546338751.80702546338751.80702546338751.80702546338751.807025463
38751.807881944438751.807881944438751.807881944438751.807881944438751.8078819444
38751.808576388938751.808576388938751.808576388938751.808576388938751.8085763889
38751.809270833338751.809270833338751.809270833338751.809270833338751.8092708333
38751.809965277838751.809965277838751.809965277838751.809965277838751.8099652778
38751.810659722238751.810659722238751.810659722238751.810659722238751.8106597222
38751.811354166738751.811354166738751.811354166738751.811354166738751.8113541667
38751.812048611138751.812048611138751.812048611138751.812048611138751.8120486111
38751.812870370438751.812870370438751.812870370438751.812870370438751.8128703704
38751.813437538751.813437538751.813437538751.813437538751.8134375
38751.814131944438751.814131944438751.814131944438751.814131944438751.8141319444
38751.814826388938751.814826388938751.814826388938751.814826388938751.8148263889
38751.815520833338751.815520833338751.815520833338751.815520833338751.8155208333
38751.816215277838751.816215277838751.816215277838751.816215277838751.8162152778
38751.816770833338751.816770833338751.816770833338751.816770833338751.8167708333
38751.817604166738751.817604166738751.817604166738751.817604166738751.8176041667
38751.818298611138751.818298611138751.818298611138751.818298611138751.8182986111
38751.818993055638751.818993055638751.818993055638751.818993055638751.8189930556
38751.819687538751.819687538751.819687538751.819687538751.8196875
38751.82016203738751.82016203738751.82016203738751.82016203738751.820162037
38751.821076388938751.821076388938751.821076388938751.821076388938751.8210763889
38751.821770833338751.821770833338751.821770833338751.821770833338751.8217708333
38751.822418981538751.822418981538751.822418981538751.822418981538751.8224189815
38751.823159722238751.823159722238751.823159722238751.823159722238751.8231597222
38751.823854166738751.823854166738751.823854166738751.823854166738751.8238541667
38751.824548611138751.824548611138751.824548611138751.824548611138751.8245486111
38751.825682870438751.825682870438751.825682870438751.825682870438751.8256828704
38751.825763888938751.825763888938751.825763888938751.825763888938751.8257638889
38751.826631944438751.826631944438751.826631944438751.826631944438751.8266319444
38751.827326388938751.827326388938751.827326388938751.827326388938751.8273263889
38751.828020833338751.828020833338751.828020833338751.828020833338751.8280208333
38751.828715277838751.828715277838751.828715277838751.828715277838751.8287152778
38751.829409722238751.829409722238751.829409722238751.829409722238751.8294097222
38751.830104166738751.830104166738751.830104166738751.830104166738751.8301041667
38751.830798611138751.830798611138751.830798611138751.830798611138751.8307986111
38751.831493055638751.831493055638751.831493055638751.831493055638751.8314930556
38751.832418981538751.832418981538751.832418981538751.832418981538751.8324189815
38751.832638888938751.832638888938751.832638888938751.832638888938751.8326388889
38751.832881944438751.832881944438751.832881944438751.832881944438751.8328819444
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.833368055638751.833368055638751.833368055638751.833368055638751.8333680556
38751.834270833338751.834270833338751.834270833338751.834270833338751.8342708333
38751.834965277838751.834965277838751.834965277838751.834965277838751.8349652778
38751.835659722238751.835659722238751.835659722238751.835659722238751.8356597222
38751.836354166738751.836354166738751.836354166738751.836354166738751.8363541667
38751.837048611138751.837048611138751.837048611138751.837048611138751.8370486111
38751.837743055638751.837743055638751.837743055638751.837743055638751.8377430556
HR beats/min
SaO2 %
"Code Blue"
RR breaths/min
ETCO2 mmHg
79
94
28
29
77
93
27
30
76
95
27
30
75
92
26
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24
31
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92
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28
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30
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27
24
85
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26
24
83
90
26
26
82
91
25
23
82
92
27
26
81
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25
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26
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29
27
81
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27
28
75
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30
27
84
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29
29
89
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27
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29
28
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91
32
26
86
90
32
26
90
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34
25
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34
25
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35
24
90
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38
26
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39
29
91
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39
24
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92
38
26
93
93
38
23
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90
37
21
96
93
35
24
89
94
38
24
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93
46
22
98
90
46
24
99
92
42
23
101
94
35
24
98
91
38
26
93
89
36
22
97
89
36
21
86
90
42
21
99
89
44
22
102
88
41
22
103
89
42
21
105
92
37
22
109
91
37
22
100
90
42
22
103
86
45
21
102
87
50
22
116
85
48
19
114
89
44
22
112
84
45
18
115
83
47
16
120
85
48
18
119
84
43
19
117
87
39
21
119
86
43
19
121
88
45
18
124
85
40
17
123
83
37
21
122
83
30
22
119
82
32
19
132
80
123
25
17
132
80
113
25
17
132
80
103
25
17
132
80
93
25
17
132
80
83
25
17
132
80
73
25
17
132
80
63
25
17
132
80
53
25
17
132
80
43
25
17
132
80
33
25
17
132
80
23
25
17
129
77
24
20
133
75
21
19
133
70
23
20
136
74
24
18
132
78
25
24
129
72
26
21
O2 supplementation may actually worsen things!
[16]
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1/31/06 23:45 2/1/06 0:57 2/1/06 2:09 2/1/06 3:21 2/1/06 4:33
SaO2 %
HR beats/min
PCA Bolus
ETCO2 mmHg
RR breaths/min
Continuous capnography/oximetry monitoring during PCA
Chart1
38749.000046296338749.000046296338749.000046296338749.000046296338749.0000462963
38749.000740740738749.000740740738749.000740740738749.000740740738749.0007407407
38749.001435185238749.001435185238749.001435185238749.001435185238749.0014351852
38749.002129629638749.
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