Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia

Recent evidence suggests that the use of low tidal volume ventilation with the application of positive end-expiratory pressure (PEEP) may benefit patients at risk of respiratory complications during general anaesthesia. However current Australian practice in this area is unknown. To describe current...

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Veröffentlicht in:BMC anesthesiology 2014-10, Vol.14 (1), p.85-85
Hauptverfasser: Karalapillai, Dharshi, Weinberg, Laurence, Galtieri, Jonathan, Glassford, Neil, Eastwood, Glenn, Darvall, Jai, Geertsema, Jake, Bangia, Ravi, Fitzgerald, Jane, Phan, Tuong, OHallaran, Luke, Cocciante, Adriano, Watson, Stuart, Story, David, Bellomo, Rinaldo
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container_title BMC anesthesiology
container_volume 14
creator Karalapillai, Dharshi
Weinberg, Laurence
Galtieri, Jonathan
Glassford, Neil
Eastwood, Glenn
Darvall, Jai
Geertsema, Jake
Bangia, Ravi
Fitzgerald, Jane
Phan, Tuong
OHallaran, Luke
Cocciante, Adriano
Watson, Stuart
Story, David
Bellomo, Rinaldo
description Recent evidence suggests that the use of low tidal volume ventilation with the application of positive end-expiratory pressure (PEEP) may benefit patients at risk of respiratory complications during general anaesthesia. However current Australian practice in this area is unknown. To describe current practice of intraoperative ventilation with regard to tidal volume and application of PEEP, we performed a multicentre audit in patients undergoing general anaesthesia across eight teaching hospitals in Melbourne, Australia. We obtained information including demographic characteristics, type of surgery, tidal volume and the use of PEEP in a consecutive cohort of 272 patients. The median age was 56 (IQR 42-69) years; 150 (55%) were male. Most common diagnostic groups were general surgery (31%), orthopaedic surgery (20%) and neurosurgery (9.6%). Mean FiO2 was 0.6 (IQR 0.5-0.7). Median tidal volume was 500 ml (IQR 450-550). PEEP was used in 54% of patients with a median value of 5.0 cmH2O (IQR 4.0-5.0) and median tidal volume corrected for predicted body weight was 9.5 ml/kg (IQR 8.5-10.4). Median peak inspiratory pressure was 18 cmH2O (IQR 15-22). In a cohort of patients considered at risk for respiratory complications, the median tidal volume was still 9.8 ml/kg (IQR 8.6-10.7) and PEEP was applied in 66% of patients with a median value of 5 cmH20 (IQR 4-5). On multivariate analyses positive predictors of tidal volume size included male sex (p 
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However current Australian practice in this area is unknown. To describe current practice of intraoperative ventilation with regard to tidal volume and application of PEEP, we performed a multicentre audit in patients undergoing general anaesthesia across eight teaching hospitals in Melbourne, Australia. We obtained information including demographic characteristics, type of surgery, tidal volume and the use of PEEP in a consecutive cohort of 272 patients. The median age was 56 (IQR 42-69) years; 150 (55%) were male. Most common diagnostic groups were general surgery (31%), orthopaedic surgery (20%) and neurosurgery (9.6%). Mean FiO2 was 0.6 (IQR 0.5-0.7). Median tidal volume was 500 ml (IQR 450-550). PEEP was used in 54% of patients with a median value of 5.0 cmH2O (IQR 4.0-5.0) and median tidal volume corrected for predicted body weight was 9.5 ml/kg (IQR 8.5-10.4). Median peak inspiratory pressure was 18 cmH2O (IQR 15-22). In a cohort of patients considered at risk for respiratory complications, the median tidal volume was still 9.8 ml/kg (IQR 8.6-10.7) and PEEP was applied in 66% of patients with a median value of 5 cmH20 (IQR 4-5). On multivariate analyses positive predictors of tidal volume size included male sex (p &lt; 0.01), height (p = 0.04) and weight (p &lt; 0.001). Positive predictors of the use of PEEP included surgery in a tertiary hospital (OR = 3.11; 95% CI: 1.05 to 9.23) and expected prolonged duration of surgery (OR = 2.47; 95% CI: 1.04 to 5.84). In mechanically ventilated patients under general anaesthesia, tidal volume was high and PEEP was applied to the majority of patients, but at modest levels. 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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Karalapillai et al.; licensee BioMed Central Ltd. 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b507t-53d909c7de3303a23a07c074719d0cc4e85d74a66185de6964d47e6aaba9b7f63</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190393/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190393/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25302048$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karalapillai, Dharshi</creatorcontrib><creatorcontrib>Weinberg, Laurence</creatorcontrib><creatorcontrib>Galtieri, Jonathan</creatorcontrib><creatorcontrib>Glassford, Neil</creatorcontrib><creatorcontrib>Eastwood, Glenn</creatorcontrib><creatorcontrib>Darvall, Jai</creatorcontrib><creatorcontrib>Geertsema, Jake</creatorcontrib><creatorcontrib>Bangia, Ravi</creatorcontrib><creatorcontrib>Fitzgerald, Jane</creatorcontrib><creatorcontrib>Phan, Tuong</creatorcontrib><creatorcontrib>OHallaran, Luke</creatorcontrib><creatorcontrib>Cocciante, Adriano</creatorcontrib><creatorcontrib>Watson, Stuart</creatorcontrib><creatorcontrib>Story, David</creatorcontrib><creatorcontrib>Bellomo, Rinaldo</creatorcontrib><title>Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia</title><title>BMC anesthesiology</title><addtitle>BMC Anesthesiol</addtitle><description>Recent evidence suggests that the use of low tidal volume ventilation with the application of positive end-expiratory pressure (PEEP) may benefit patients at risk of respiratory complications during general anaesthesia. 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In a cohort of patients considered at risk for respiratory complications, the median tidal volume was still 9.8 ml/kg (IQR 8.6-10.7) and PEEP was applied in 66% of patients with a median value of 5 cmH20 (IQR 4-5). On multivariate analyses positive predictors of tidal volume size included male sex (p &lt; 0.01), height (p = 0.04) and weight (p &lt; 0.001). Positive predictors of the use of PEEP included surgery in a tertiary hospital (OR = 3.11; 95% CI: 1.05 to 9.23) and expected prolonged duration of surgery (OR = 2.47; 95% CI: 1.04 to 5.84). In mechanically ventilated patients under general anaesthesia, tidal volume was high and PEEP was applied to the majority of patients, but at modest levels. 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However current Australian practice in this area is unknown. To describe current practice of intraoperative ventilation with regard to tidal volume and application of PEEP, we performed a multicentre audit in patients undergoing general anaesthesia across eight teaching hospitals in Melbourne, Australia. We obtained information including demographic characteristics, type of surgery, tidal volume and the use of PEEP in a consecutive cohort of 272 patients. The median age was 56 (IQR 42-69) years; 150 (55%) were male. Most common diagnostic groups were general surgery (31%), orthopaedic surgery (20%) and neurosurgery (9.6%). Mean FiO2 was 0.6 (IQR 0.5-0.7). Median tidal volume was 500 ml (IQR 450-550). PEEP was used in 54% of patients with a median value of 5.0 cmH2O (IQR 4.0-5.0) and median tidal volume corrected for predicted body weight was 9.5 ml/kg (IQR 8.5-10.4). Median peak inspiratory pressure was 18 cmH2O (IQR 15-22). 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subjects Adult
Aged
Anesthesia, General - methods
Australia
Cohort Studies
Female
Humans
Injuries
Male
Medical Audit
Middle Aged
Patients
Positive-Pressure Respiration - methods
Prospective Studies
Respiration, Artificial - standards
Respiration, Artificial - trends
Respiratory diseases
Respiratory distress syndrome
Respiratory Rate
Tidal Volume
Ventilators
title Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia
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