Prediction of Cardiorespiratory Compromise on Hospital General Care Units: Are We There Yet?


Patients recovering from surgery on a hospital’s general care unit have core vital signs checked once every 4–6 hours, which leaves them unmonitored 96 percent of their total time spent on the general care floor. Vital signs deteriorate 6–12 hours before cardiac and respiratory arrests occur creating a ‘window of opportunity’ for early detection and intervention. Everything may seem fine at these ‘snapshot’ checkups but a patient’s breathing may deteriorate, especially when not being awakened during checks, and go unnoticed until the patient develops cardiorespiratory compromise – which might be too late.

Cardiorespiratory complications are the most common cause of 30-day post-operative mortality. Currently no tool reliably predicts which patients are at risk. The literature on cardiorespiratory compromise suggests continuous, electronic monitoring may aid in early recognition. However, a key question is who to monitor, what to monitor and how best to monitor?

In this webinar, Dr. Khanna will describe:

  • The underlying causes of cardiorespiratory compromise
  • Challenges of predicting episodes or severity of cardiorespiratory compromise in patients who appear to be in stable condition on the general care floor
  • How continuous cardiorespiratory monitoring may inform early intervention and mitigate further deterioration
  • Progress toward predicting cardiorespiratory compromise on the general care floor
    • Particularly PRODIGY, a global trial i participated in to develop a respiratory depression prediction tool, and examine the value of continuous capnography and oximetry monitoring https://www.sciencedirect.com/science/article/pii/S088394411830217X
    • Curry JP and Jungquist CR.  A critical assessment of monitoring practices, patient deterioration, and alarm fatigue on inpatient wards: a review. Patient Safety in Surgery 2014, 8:29.


At the end of the webinar, attendees will be able to:

  • Describe the challenges of predicting cardiorespiratory compromise, and how to address them
  • Summarize potential benefits of continuous monitoring on the general care floor to improve outcomes
  • Identify who to monitor as well as what and how to monitor
  • Translate expanded knowledge of cardiorespiratory compromise into improvements in practice and patient monitoring protocols – integrate better in-patient monitoring on the general care floors

Speaker Bio

Ashish Khanna, MD, FCCP, FCCM is a staff intensivist with the Center for Critical Care and assistant professor of anesthesiology at the Cleveland Clinic Lerner College of Medicine in Cleveland, Ohio.

In addition, he is the Vice-Chief for Research for the Center for Critical Care and Quality Director for the Cleveland Clinic post-ICU joint venture. He is the immediate past chair of the Society of Critical Care Medicine’s (SCCM) In-Training Section and the current chair for the Postgraduate and Fellowship Education Committee. He is a recent recipient of the SCCM presidential citation for the years 2016 & 2017 and a successful nominee as an honorary fellow of the American College of Critical Care Medicine (FCCM) in 2018. Dr. Khanna is the incoming vice-chair for the American Society of Anesthesiologists (ASA) committee on critical care medicine. 

His research interests include, prediction of post-operative respiratory and cardiac events on the regular nursing floor, outcomes of hypotension in critically ill patients and novel vasopressors in shock states in the ICU.

From 2015-2017 Dr. Khanna was a lead investigator in the Angiotensin II in High Output Shock (ATHOS-3) trial that was subsequently published in the NEJM in the summer of 2017. 

He also recently led and completed the Prediction of Opioid Induced Respiratory Depression in Patients Monitored by Capnography (PRODIGY) trial in 16 sites across the world. He has more than 50 peer reviewed papers, more than two dozen book chapters, invited non-peer revised articles, and online education videos to his credit.

He is also a recent recipient of the prestigious Foundation for Anesthesia Education and Research (FAER) grant sponsored by the American Society of Anesthesiologists, where his work will focus on continuous postoperative hemodynamic and respiratory monitoring in patients on the hospital general care units.

Slides and Recording

  • Recording available after registering here
  • Slides are attached in the right-side panel

Survey and CE Information

  • To better serve the HQI and CHPSO audience, please complete this short survey.
  • One CE unit will be provided to HQI, CHPSO, or CHA members who attended the webinar for the entire hour. Please complete the survey in the link above by October 15.
  • A CE certificate will be emailed within 3-5 business days.

CE Notice:

HQI is an approved continuing education (CE) provider by the California Board of Registered Nursing and will provide CHPSO members an opportunity to earn CEs. Provider Number CEP16793 for 1.0 contact hour.

CHPSO does not currently offer ACPE approved Pharmacy CE, but the State of California will accept CE from courses which have been approved for continuing education by the Medical Board of California, the California Board of Podiatric Medicine, the California Board of Registered Nursing or the Dental Board of California towards their California continuing education requirement (Section 1732.2(b) of the California Code of Regulations). Pharmacists need to keep track of CE from these sources on their own as they are not submitted to NAPB.

Please contact CHPSO at info@chpso.org if you have any questions.

PRODIGY Trial and Respiratory Monitoring Tool Kit