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Respiratory System Damaging Events

Journal Articles

  1. Caplan RA, Posner KL, Ward RJ, Cheney FW: Adverse respiratory events in anesthesia: A closed claims analysis. Anesthesiology 72:828-833, 1990. [Abstract, NLM PubMed Link].
    1. A review of 1,541 cases from the ASA Closed Claims database showed that three mechanisms of injury accounted for three-fourths of the adverse respiratory events: inadequate ventilation (196 claims; 38%), esophageal intubation (94 claims; 18%), and difficult tracheal intubation (87 claims; 17%). The esophageal intubation group was notable in that in 48% of the cases where auscultation of breath sounds were performed and documented, this test led to the erroneous conclusion that the endotracheal tube was correctly located in the trachea.
  2. Cheney FW, Posner KL, Caplan RA: Adverse respiratory events infrequently leading to malpractice suits. Anesthesiology 75:932-939, 1991. [Abstract, NLM PubMed Link]
    1. This report is concerned with five categories of adverse respiratory events, airway trauma (97 claims, 5% of the database), pneumothorax (67 claims, 3% of database), airway obstruction (56 claims, 3% of the database), aspiration (56 claims, 3% of the database) and bronchospasm (40 claims, 2% of the database). Airway trauma was associated with difficult intubation in 42% of the claims and the most frequent sites of injury were larynx, pharynx and esophagus. Pneumothorax was usually either needle related (block or central vascular catheter placement) or airway management related (instrumentation or barotrauma). Bronchospasm tended to occur during induction of general anesthesia in patients with a history of asthma or COPD and/or smoking.
  3. Domino KB, Posner KL, Caplan RA, Cheney FW: Airway injury during anesthesia. A closed claims analysis. Anesthesiology 91:1703-1711, 1999. [Abstract, NLM PubMed Link]
  4. Peterson GN, Domino KB, Caplan RA, Posner KL, Lee LA, Cheney FW. Management of the Difficult Airway: A Closed Claims Analysis. Anesthesiology. 2005 Jul;103(1):33-39. [Abstract, NLM PubMed Link]
    1. Death or brain damage in claims from difficult airway management associated with induction of anesthesia but not other phases of anesthesia decreased in 1993-1999 compared with 1985-1992. Development of additional management strategies for difficult airways encountered during maintenance, emergence, or recovery from anesthesia may improve patient safety.
  5. Robbertze R, Posner KL, Domino KB. Closed claims review of anesthesia for procedures outside the operating room. Current Opinion in Anesthesiology. 2006 19:436-442. [NLM PubMed Link]. See also: Monitoring - Physiologic, Respiratory System. Order this article from: Journal Website
    1. Nonoperating-room anesthesia claims had a higher severity of injury and more substandard care than operating room claims. Inadequate oxygenation / ventilation was the most common mechanism of injury.
  6. Cheney FW, Posner KL, Lee LA, Caplan RA, Domino KB. Trends in Anesthesia-related Death and Brain Damage: A Closed Claims Analysis. Anesthesiology. 2006 Dec;105(6):1081-1086. [Abstract, NLM PubMed Link] See also: Respiratory System, Malpractice System, Monitoring - Physiologic. Order this article from: Journal Website
    1. The significant decrease in the proportion of claims for death or permanent brain damage from 1975 through 2000 seems to be unrelated to a marked increase in the proportion of claims where pulse oximetry and end-tidal carbon dioxide monitoring were used. After the introduction and use of these monitors, there was a significant reduction in the proportion of respiratory and an increase in the proportion of cardiovascular damaging events responsible for death or permanent brain damage
  7. Metzner J, Posner KL, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009 Aug;22(4):502-8. [NLM PubMed Link]. See also: Quality of Care
    1. This analysis of claims since 1990 compared 87 claims for anesthesia in remote locations to 3287 claims from OR procedures. Remote location claims involved older and sicker patients and utilized MAC in 50% of claims. Claims from remote locations had more severe injuries than OR claims, with a higher proportion of death and respiratory damaging events. Our data suggests that anesthesia at remote locations poses a significant risk for the patient, particularly related to oversedation and inadequate oxygenation/ventilation during monitored anesthesia care.
  8. Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anaesthesiol. 2011 Jun;25(2):263-76. [NLM PubMed Link] See also: Monitoring - Physiology, Project Overview, Quality of Care, Regional / MAC.
    1. The profile of anesthesia liability changed over the decades, including the types of anesthesia care associated with claims as well as events and injuries leading to claims. The most common complications in 1990-2007 were death, nerve injury and permanent brain damage. The most common anesthesia-related events leading to claims were regional-block related, respiratory, cardiovascular and equipment-related. This review includes focus on liability related to the difficult airway, monitored anesthesia care, non-operating room locations, obstetric anesthesia, and chronic pain management.

Newsletter Articles

  1. Zeitlin GL: Recovery room mishaps in the ASA Closed Claims Study. ASA Newsletter 53(7):28-30, 1989. [Full Text] See also: Monitoring - Physiologic
  2. Cheney FW: ASA Closed Claims Project progress report: The effect of pulse oximetry and end-tidal CO2 monitoring on adverse respiratory events. ASA Newsletter 56(6):6-10, 1992. See also: Monitoring - Physiologic
  3. Domino KB: Closed Malpractice Claims for Airway Trauma During Anesthesia. ASA Newsletter 62(6):10-11, 1998. [Full Text]
  4. Cheney, FW: Aspiration: A Liability Hazard for the Anesthesiologist? ASA Newsletter 64(6):5-6 & 26, 2000. [Full Text; PDF Version]
  5. Miller, CG: Management of the Difficult Intubation in Closed Malpractice Claims. ASA Newsletter 64(6):13-16 & 19, 2000. [Full Text; PDF Version]
  6. Cheney, FW: Changing Trends in Anesthesia-Related Death and Permanent Brain Damage ASA Newsletter 66(6): 6-8, 2002. [Full Text; PDF Version] See also: Malpractice System
  7. Metzner JI: Risks of anesthesia at remote locations. ASA Newsletter 74(2): 17-18, 2010. [Full Text; PDF Version] See also: Quality of Care
  8. Metzner J, Domino KB: Risks of anesthesia care in remote locations. Anesthesia Patient Safety Foundation (APSF) Newsletter 26(1):5-6, 2011. See also:Quality of Care
  9. Bailie, R., Posner, K.L.: New trends in adverse respiratory events from the ASA Closed Claims Project. ASA Newsletter 75(2): 28-29, 2011. [PDF Version courtesy of ASA] See also: Respiratory System.

Conference Presentations and ASA Abstracts

  1. Peterson GN, Posner KL, Domino KB, Lee LA, Cheney FW: Management of the Difficult Airway in Closed Malpractice Claims. Anesthesiology, 99: A1252, 2003. [Full Text]