Intraoperative Lung-Protective Ventilation Trends and Practice Patterns: A Report from the Multicenter Perioperative Outcomes Group.
BACKGROUND
The use of an intraoperative lung-protective ventilation strategy through tidal volume (TV) size reduction and positive end-expiratory pressure (PEEP) has been increasingly investigated. In this article, we describe the current intraoperative lung-protective ventilation practice patterns and trends.


METHODS
By using the Multicenter Perioperative Outcomes Group database, we identified all general endotracheal anesthetics from January 2008 through December 2013 at 10 institutions. The following data were calculated: (1) percentage of patients receiving TV > 10 mL/kg predicted body weight (PBW); (2) median initial and overall TV in mL/kg PBW and; (3) percentage of patients receiving PEEP ≥ 5 cm H2O. The data were analyzed at 3-month intervals. Interinstitutional variability was assessed.


RESULTS
A total of 330,823 patients met our inclusion criteria for this study. During the study period, the percentage of patients receiving TV > 10 mL/kg PBW was reduced for all patients (26% to 14%) and in the subpopulations of obese (41% to 25%), short stature (52% to 36%), and females (39% to 24%; all P values <0.001). There was a significant reduction in TV size (8.90-8.20 mL/kg PBW, P < 0.001). There was also a statistically significant but clinically irrelevant difference between initial and overall TV size (8.65 vs 8.63 mL/kg PBW, P < 0.001). Use of PEEP ≥ 5 cm H2O increased during the study period (25%-45%, P < 0.001). TV usage showed significant interinstitutional variability (P < 0.001).


CONCLUSIONS
Although decreasing, a significant percentage of patients are ventilated with TV > 10 mL/kg PBW, especially if they are female, obese, or of short stature. The use of PEEP ≥ 5 cm H2O has increased significantly. Creating awareness of contemporary practice patterns and demonstrating the efficacy of lung-protective ventilation are still needed to optimize intraoperative ventilation.
From the *Department of Anesthesiology, University of Vermont College of Medicine, Burlington, Vermont; †Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, Michigan; ‡Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, Virginia; and §Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado.
S Patrick
SP
Bender
William C
WC
Paganelli
Lyle P
LP
Gerety
William G
WG
Tharp
Amy M
AM
Shanks
Michelle
M
Housey
Randal S
RS
Blank
Douglas A
DA
Colquhoun
Ana
A
Fernandez-Bustamante
Leslie C
LC
Jameson
Sachin
S
Kheterpal
D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods / Q000639:trends*; D008168:Lung / Q000502:physiology*; D008297:Male; D011175:Positive-Pressure Respiration / Q000379:methods / Q000639:trends*; D058028:Research Report / Q000639:trends*; D012189:Retrospective Studies; D013990:Tidal Volume / Q000502:physiology*; D016896:Treatment Outcome