Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna

In this 128th episode I welcome Dr. Ashish Khanna to the show to discuss his trial, the PRODIGY trial, looking at opioid induced respiratory depression. We discuss the background of the trial, what it took to run a 16 site, 3 continent trial, what the risk factors were that went into the risk prediction model they developed, and where we go from here.

References:

Sun Z, Sessler DI, Dalton JE, et al. Postoperative Hypoxemia Is Common and Persistent: A Prospective Blinded Observational Study. Anesth Analg. 2015;121(3):709–715. doi:10.1213/ANE.0000000000000836

Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, Domino KB. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015 Mar;122(3):659-65. doi: 10.1097/ALN.0000000000000564.

4 Replies to “Episode 128: Opioid Induced Respiratory Depression (The PRODIGY Trial) with Dr. Ashish Khanna”

    1. Hi Sultana,

      I’m not sure why the links didn’t work but I’ve replaced them with citations. Thanks for pointing that out!

  1. Hi! As a PACU RN at Duke University Hospital I found this very interesting. I would love to know more about the implications in the PACU setting and if we can potentially flag patients going to an intermediate floor with a higher potential of respiratory depression in our setting while we are continuously monitoring them. Also, if Dr. Khanna can answer this question: how often were respiratory depression events linked to opioids given in the PACU? Treating pain while maintaining respiratory drive is an art that is learned but we don’t get to see what the implications are later in the patient’s hospital stay. Was there a higher risk with IV vs PO opioids? Can we minimize the risk with interventions such as cough & deep breathe/incentive spirometry/etc.? Does CPAP compliance make a different in patients with OSA? Thanks!

    1. Hi Molly, great questions, here is Dr. Khanna’s response:

      The concern for ‘predicting’ RD based on respiratory patterns in the PACU is extremely important. ( and a critical area of predictive analytics ). Several investigators have utilized datasets and associated varied response parameters in the PACU with postoperative pulmonary complications. PRODIGY was a trial of continuous monitoring ( data collected ) in a traditionally non-monitored area ( floor). PACU itself may not be the best place to look for OIRD, since patients are continuously monitored and most respiratory alarms are responded to with adequate concern. Now, did we or can we link the 1st RD alarm on the floor to the last opioid in the PACU may deserve more investigation and I encourage this RN at Duke to think of an investigator initiated grant and attempt to contact the study sponsor with this idea. ( I am happy to collaborate, help and guide).

      And yes, I agree with CPAP compliance and threats such as OSA (these are real issues).

      He’s happy to be in touch if you want to talk more, you can contact him at ashish@or.org.

      Best,
      Jed

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