SIR: Better tactics needed to avert respiratory failure

Better strategies are needed for the prevention and management of respiratory compromise in interventional radiology sedation procedures, according to research presented at the Society of Interventional Radiology (SIR) annual meeting in Los Angeles.

A team led by Dr. Richard Urman of Brigham and Women's Hospital in Boston found a more than 9% incidence of acute respiratory compromise events for hospital patients undergoing interventional radiology procedures using sedation. Respiratory compromise is a state in which there is a high likelihood of decompensation into respiratory insufficiency, respiratory failure, or death.

Urman's team identified 67,356 acute respiratory events out of 718,497 hospital interventional radiology sedation procedures, for a combined average respiratory compromise event rate of 9.4% and a combined average death rate of 4.4% across 12 therapeutic categories included in the study.

The group found the following:

  • The top three respiratory compromise rates by category were clot management (14.5%), vascular access (11.4%), and percutaneous biopsy (6.9%).
  • The highest death rates were in clot management (7.4%), vascular access (6.1%), biliary stenting/drainage (3.5%), and gastrointestinal interventions (3.5%).
  • Lowest respiratory compromise event rates were found in urological interventions (4.4%), peripheral vascular (4.4%), and oncology (2.1%).

"Given the substantial rate of respiratory compromise events observed in this study, better strategies for the prevention and management of respiratory compromise events in interventional radiology sedation procedures is warranted, and if addressed would likely improve overall patient outcomes and result in substantial healthcare savings," the team concluded.

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