Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study
Canadian Journal of Anesthesia/Journal canadien d anesthésie
Abstract
Intraoperative lung protective ventilation and, in inhalational anesthesia, minimal fresh gas flow (FGF) are recommended. It remains unclear how these recommendations are transferred to clinical routine. We aimed to assess corresponding anesthesia practices in Germany and raise awareness of optimal ventilation settings. We performed a pragmatic prospective observational national cross-sectional assessment of intraoperative ventilation settings in Germany, followed by an educational intervention and follow-up assessment. The intervention consisted of a pocket card designed in a Delphi-process. The patient-centred primary endpoint was tidal volume (V T )·kg −1 ideal body weight (IBW), and the environment-centred primary endpoint was FGF in inhalational anesthesia. In a post hoc analysis, we grouped departments into quintiles of baseline V T and FGF, and explored changes after the intervention. Over 240 of 1,148 anesthesiology departments participated (21%). We collected data from 2,198 operating rooms in the first (preintervention) and 2,106 in the second (postintervention) assessment (96% response rate). The mean (standard deviation) V T ·kg −1 IBW was 7.4 (1.4) mL in the first assessment vs 7.3 (1.3) mL in the second assessment. The median [interquartile range (IQR)] FGFs were 0.60 [0.50–0.85] L·min −1 vs 0.50 [0.45–0.75] L·min −1 , respectively. Exploratory multilevel regression analysis did not show an effect of the intervention. In the anesthesiology departments whose baseline ventilation settings were in the highest quintile, the intervention was associated with improvements in both V T and FGF. This large-scale clinical study of intraoperative ventilation settings in Germany found that most anesthesiologists already followed current recommendations. Therefore, for the entire cohort, no major improvements were observed. The educational intervention might improve ventilation settings in anesthesiology departments whose baseline practice deviates strongly from current recommendations.
Authors 19
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Affiliation as printed
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany. lgruesser@ukaachen.de
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Affiliation as printed
Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Julia Wallqvist Aachen Alexianer Center for Mental Health Department of Anesthesiology Faculty of Medicine
Affiliation as printed
Alexianer Center for Mental Health, Aachen, Germany
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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Otto-von-Guericke-Universität Magdeburg
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany
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University of Vechta · University Hospital Münster
Affiliation as printed
Department of Anesthesia, Intensive Care Medicine & Emergency Medicine, St. Marienhospital Vechta, Vechta, Germany
Department of Anesthesiology, Operative Intensive Care Medicine and Pain Medicine, Universitätsklinikum Münster, Münster, Germany
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University Hospital Carl Gustav Carus · Technische Universität Dresden
Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany
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Affiliation as printed
Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Christliches Krankenhaus Quakenbrück, Quakenbrück, Germany
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Affiliation as printed
Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal, Rechbergklinik Bretten, Bruchsal, Germany
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BG Klinikum Bergmannstrost Halle · Martin Luther University Halle-Wittenberg
Affiliation as printed
Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital, Halle, Germany
Faculty of Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany
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Affiliation as printed
Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum Traunstein, Traunstein, Germany
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Affiliation as printed
Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany
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Affiliation as printed
Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany
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