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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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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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 < 0.01), height (p = 0.04) and weight (p < 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. The findings of our study suggest that the control groups of previous randomized controlled trials do not closely reflect the practice of mechanical ventilation in Australia.</description><identifier>ISSN: 1471-2253</identifier><identifier>EISSN: 1471-2253</identifier><identifier>DOI: 10.1186/1471-2253-14-85</identifier><identifier>PMID: 25302048</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>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</subject><ispartof>BMC anesthesiology, 2014-10, Vol.14 (1), p.85-85</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>2014 Karalapillai et al.; licensee BioMed Central Ltd. 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. 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 < 0.01), height (p = 0.04) and weight (p < 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. The findings of our study suggest that the control groups of previous randomized controlled trials do not closely reflect the practice of mechanical ventilation in Australia.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia, General - methods</subject><subject>Australia</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Humans</subject><subject>Injuries</subject><subject>Male</subject><subject>Medical Audit</subject><subject>Middle Aged</subject><subject>Patients</subject><subject>Positive-Pressure Respiration - methods</subject><subject>Prospective Studies</subject><subject>Respiration, Artificial - standards</subject><subject>Respiration, Artificial - trends</subject><subject>Respiratory diseases</subject><subject>Respiratory distress syndrome</subject><subject>Respiratory Rate</subject><subject>Tidal Volume</subject><subject>Ventilators</subject><issn>1471-2253</issn><issn>1471-2253</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kk1v1DAQhi0EoqVw5oYsceFAih3HdsKh0rLiSyriAmdrYs9uXSX2Eicr8e-ZVUvpIpAlezR-5h3PKzP2XIpzKVvzRjZWVnWtVSWbqtUP2Old5uG9-IQ9KeVaCGlboR6zE0qJWjTtKQvrZZowzXxPWxxgjjnx3QR-jh55WKaYtnyLCScYOCTAMl9hifCWA2G57JDIPXJYQpx5TPwLDn1epoSv-WopM5VFeMoebWAo-Oz2PGPfP7z_tv5UXX79-Hm9uqx6LexcaRU60XkbUCmhoFYgrBeWhuiC8L7BVgfbgDGSAjSdaUJj0QD00PV2Y9QZu7jR3S39iMHTSNTf7aY4wvTTZYju-CbFK7fNe9fITqhOkcC7G4E-5v8IHN_4PLqDy-7gMkWu1STy6vYVU_6xkGFujMXjMEDCvBQnjRRW685YQl_-hV4fvCOPnNStEY0xtflDbWFAF9MmU29_EHUrrTptayFros7_QdEKOEafE24i5Y8KXtx3627K359D_QLaS7vj</recordid><startdate>20141001</startdate><enddate>20141001</enddate><creator>Karalapillai, Dharshi</creator><creator>Weinberg, Laurence</creator><creator>Galtieri, Jonathan</creator><creator>Glassford, Neil</creator><creator>Eastwood, Glenn</creator><creator>Darvall, Jai</creator><creator>Geertsema, Jake</creator><creator>Bangia, Ravi</creator><creator>Fitzgerald, Jane</creator><creator>Phan, Tuong</creator><creator>OHallaran, Luke</creator><creator>Cocciante, Adriano</creator><creator>Watson, Stuart</creator><creator>Story, David</creator><creator>Bellomo, Rinaldo</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20141001</creationdate><title>Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b507t-53d909c7de3303a23a07c074719d0cc4e85d74a66185de6964d47e6aaba9b7f63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia, General - methods</topic><topic>Australia</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Humans</topic><topic>Injuries</topic><topic>Male</topic><topic>Medical Audit</topic><topic>Middle Aged</topic><topic>Patients</topic><topic>Positive-Pressure Respiration - methods</topic><topic>Prospective Studies</topic><topic>Respiration, Artificial - standards</topic><topic>Respiration, Artificial - trends</topic><topic>Respiratory diseases</topic><topic>Respiratory distress syndrome</topic><topic>Respiratory Rate</topic><topic>Tidal Volume</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC anesthesiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karalapillai, Dharshi</au><au>Weinberg, Laurence</au><au>Galtieri, Jonathan</au><au>Glassford, Neil</au><au>Eastwood, Glenn</au><au>Darvall, Jai</au><au>Geertsema, Jake</au><au>Bangia, Ravi</au><au>Fitzgerald, Jane</au><au>Phan, Tuong</au><au>OHallaran, Luke</au><au>Cocciante, Adriano</au><au>Watson, Stuart</au><au>Story, David</au><au>Bellomo, Rinaldo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia</atitle><jtitle>BMC anesthesiology</jtitle><addtitle>BMC Anesthesiol</addtitle><date>2014-10-01</date><risdate>2014</risdate><volume>14</volume><issue>1</issue><spage>85</spage><epage>85</epage><pages>85-85</pages><issn>1471-2253</issn><eissn>1471-2253</eissn><abstract>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 < 0.01), height (p = 0.04) and weight (p < 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. The findings of our study suggest that the control groups of previous randomized controlled trials do not closely reflect the practice of mechanical ventilation in Australia.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>25302048</pmid><doi>10.1186/1471-2253-14-85</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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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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