PMID- 27123237
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20160428
LR  - 20220317
IS  - 2047-0525 (Print)
IS  - 2047-0525 (Electronic)
IS  - 2047-0525 (Linking)
VI  - 5
DP  - 2016
TI  - Intra-operative adherence to lung-protective ventilation: a prospective 
      observational study.
PG  - 8
LID - 10.1186/s13741-016-0033-4 [doi]
LID - 8
AB  - BACKGROUND: Lung-protective ventilation in patients with acute respiratory 
      distress syndrome improves mortality. Adopting this strategy in the perioperative 
      period has been shown to reduce lung inflammation and postoperative pulmonary and 
      non-pulmonary sepsis complications in patients undergoing major abdominal 
      surgery. We conducted a prospective observational study into the intra-operative 
      ventilation practice across the West Midlands to assess the use of 
      lung-protective ventilation. METHODS: Data was collected from all adult 
      ventilated patients undergoing surgery across 14 hospital trusts in the West 
      Midlands over a 2-day period in November 2013. Data collected included surgical 
      specialty, patient's biometric data, duration of procedure, grade of anesthetist, 
      and ventilatory parameters. Lung-protective ventilation was defined as the 
      delivery of a tidal volume between 6 and 8 ml/kg/predicted body weight, a peak 
      pressure of less than 30 cmH2O, and the use of positive end expiratory pressure 
      of 6-8 cmH2O. Categorical data are presented descriptively, while non-parametric 
      data are displayed as medians with statistical tests from Mann-Whitney U tests or 
      Kruskal-Wallis tests for independent samples while paired samples are represented 
      by Wilcoxon signed rank tests. RESULTS: Four hundred six patients with a median 
      age of 56 years (16-91) were included. The majority of operations (78 %) were 
      elective procedures with the principal anesthetist being a consultant. The 
      commonest surgical specialties were general (29 %), trauma and orthopedic (19 %), 
      and ENT (17 %). Volume-controlled ventilation was the preferred ventilation 
      strategy in 70 % of cases. No patients were ventilated using lung-protective 
      ventilation. Overall peak airway pressure (pPeak) was low (median 20 cmH2O 
      (inter-quartile range [IQR] 10-43 cmH2O)) with median delivered tidal volumes of 
      8.4 ml/kg/predicted body weight (PBW) (IQR 3.5-14.5 ml/kg/PBW). The median 
      positive end expiratory pressure (PEEP) was only 4 cmH2O (0-5 cmH2O) with PEEP 
      not used in 152 cases. CONCLUSIONS: Perioperative lung protection ventilation can 
      improve patient outcomes from major surgery. This large prospective study 
      demonstrates that within the West Midlands lung-protective ventilation during the 
      perioperative period is uncommon, especially in relation to the use of PEEP, and 
      that perhaps further trials are required to promote wider adoption of practice.
FAU - Patel, Jaimin M
AU  - Patel JM
AD  - Institute of Inflammation and Ageing, College of Medical and Dental Sciences, 
      University of Birmingham, Birmingham, UK.
FAU - Baker, Roisin
AU  - Baker R
AD  - Department of Anaesthesia, University Hospital Birmingham NHS Foundation Trust, 
      Birmingham, UK.
FAU - Yeung, Joyce
AU  - Yeung J
AD  - Institute of Inflammation and Ageing, College of Medical and Dental Sciences, 
      University of Birmingham, Birmingham, UK.
FAU - Small, Charlotte
AU  - Small C
AD  - Department of Anaesthesia, University Hospital Birmingham NHS Foundation Trust, 
      Birmingham, UK.
CN  - West Midlands-Trainee Research and Audit Network (WM-TRAIN)
LA  - eng
GR  - PDF-2014-07-061/DH_/Department of Health/United Kingdom
PT  - Journal Article
DEP - 20160427
PL  - England
TA  - Perioper Med (Lond)
JT  - Perioperative medicine (London, England)
JID - 101609072
PMC - PMC4847258
EDAT- 2016/04/29 06:00
MHDA- 2016/04/29 06:01
PMCR- 2016/04/27
CRDT- 2016/04/29 06:00
PHST- 2015/11/16 00:00 [received]
PHST- 2016/04/08 00:00 [accepted]
PHST- 2016/04/29 06:00 [entrez]
PHST- 2016/04/29 06:00 [pubmed]
PHST- 2016/04/29 06:01 [medline]
PHST- 2016/04/27 00:00 [pmc-release]
AID - 33 [pii]
AID - 10.1186/s13741-016-0033-4 [doi]
PST - epublish
SO  - Perioper Med (Lond). 2016 Apr 27;5:8. doi: 10.1186/s13741-016-0033-4. eCollection 
      2016.