Dataset Information

Variability in the Use of Protective Mechanical Ventilation During General Anesthesia.

ABSTRACT: BACKGROUND:The purpose of this study was to determine whether significant variation exists in the use of protective ventilation across individual anesthesia providers and whether this difference can be explained by patient, procedure, and provider-related characteristics. METHODS:The cohort consisted of 262 anesthesia providers treating 57,372 patients at a tertiary care hospital between 2007 and 2014. Protective ventilation was defined as a median positive end-expiratory pressure of 5 cm H2O or more, tidal volume of <10 mL/kg of predicted body weight and plateau pressure of <30 cm H2O. Analysis was performed using mixed-effects logistic regression models with propensity scores to adjust for covariates. The definition of protective ventilation was modified in sensitivity analyses. RESULTS:In unadjusted analysis, the mean probability of administering protective ventilation was 53.8% (2.5th percentile of provider 19.9%, 97.5th percentile 80.8%). After adjustment for a large number of covariates, there was little change in the results with a mean probability of 51.1% (2.5th percentile 24.7%, 97.5th percentile 77.2%). The variations persisted when the thresholds for protective ventilation were changed. CONCLUSIONS:There was significant variability across individual anesthesia providers in the use of intraoperative protective mechanical ventilation. Our data suggest that this variability is highly driven by individual preference, rather than patient, procedure, or provider-related characteristics.

SUBMITTER: Ladha KS

PROVIDER: S-EPMC6696999 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Variability in the Use of Protective Mechanical Ventilation During General Anesthesia.

Ladha Karim S KS Bateman Brian T BT Houle Timothy T TT De Jong Myrthe A C MAC Vidal Melo Marcos F MF Huybrechts Krista F KF Kurth Tobias T Eikermann Matthias M

Anesthesia and analgesia 20180201 2

<h4>Background</h4>The purpose of this study was to determine whether significant variation exists in the use of protective ventilation across individual anesthesia providers and whether this difference can be explained by patient, procedure, and provider-related characteristics.<h4>Methods</h4>The cohort consisted of 262 anesthesia providers treating 57,372 patients at a tertiary care hospital between 2007 and 2014. Protective ventilation was defined as a median positive end-expiratory pressure ...[more]

PMID: 28763357

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Project description:BackgroundAtelectasis during general anesthesia is a risk for perioperative complications. EIT measurements were performed in mechanically ventilated healthy children during elective surgery to demonstrate the changes in ventilation distribution during general anesthesia. The ventilation distribution was quantified by calculating the Global Inhomogeneity index (GI).MethodsEIT measurements were performed in 23 children (9 weeks-10 years) without lung disease to detect changes in regional ventilation during elective surgery. Three previously defined time points were marked during the measurement: after intubation and start of pressure-controlled ventilation (PCV), change to pressure support ventilation (PSV), and after extubation (spontaneous breathing-SB). Ventilation distribution based on regions of interest (ROI) and changes in end-expiratory volume (∆EELV) were collected at these time points and compared. The Global Inhomogeneity index was calculated at the beginning of pressure-controlled ventilation (PCV).ResultsWith increasing spontaneous breathing, dorsal recruitment of atelectasis occurred. The dorsal ventilation fraction increased over the time of general anesthesia with increasing spontaneous breathing, whereas the ventral fraction decreased relatively (Difference ± 5.5 percentage points respectively; 95% CI; 3.5-7.4; p < 0.001). With the onset of spontaneous breathing, there was a significant reduction in end-expiratory volume (Difference: 105 ml; 95% CI, 75-135; p < 0.001). The GI of the lung-healthy ventilated children is 47% (SD ± 4%).ConclusionControlled ventilation of healthy children resulted in increased ventilation of the ventral and collapse of the dorsal lung areas. Restart of spontaneous breathing after cessation of surgery resulted in an increase in ventilation in the dorsal with decrease in the ventral lung areas. By calculating the GI, representing the ratio of more to less ventilated lung areas, revealed the presumed homogeneous distribution of ventilation.Trial registrationClinicalTrials.gov Registration ID: NCT04873999. First registration: 05/05/2021.

Dataset Information

Variability in the Use of Protective Mechanical Ventilation During General Anesthesia.

Publications

Variability in the Use of Protective Mechanical Ventilation During General Anesthesia.

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