Skip to main content

Table 2 The Three Clinical Pattern Types of Unexpected Hospital Death (PUHD)

From: Patterns of unexpected in-hospital deaths: a root cause analysis

TYPE I Hyperventilation Compensated Respiratory Distress ( e.g. Sepsis, PE, CHF)
  Stable SPO2 with progressively falling PaCO2 eventually yields to slow SPO2 decline (mitigated by respiratory alkalosis) and followed by precipitous SPO2 decline when metabolic acidosis dominates
TYPE II Progressive Unidirectional Hypoventilation (CO2 Narcosis)
  Progressive rise in PaCO2 (and etCO2) and fall in SPO2 over 15 minutes to many hours. (Often due to overdosing of narcotics or sedatives)
TYPE III Sentinel Rapid Airflow/SPO2 Reductions Followed by Precipitous SPO2 Fall.
  A state of "arousal dependent survival" that occurs only during sleep. Arousal failure allows precipitous hypoxemia during apnea causing terminal arousal arrest.