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Quick reference tidal volume cards reduce the incidence of large tidal volumes during surgery

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Abstract

Ventilation with large tidal volumes (V T), greater than 10 ml/kg of predicted body weight (PBW), is associated with worse outcomes in critically ill and surgical patients. We hypothesized that the availability of quick reference cards with proposed V T ranges specific to gender and different heights would reduce the intraoperative use of large V T during prolonged abdominal surgery. We compared retrospectively the incidence of median V T used during prolonged (≥4-h-long) abdominal surgery before (“before”) and after (“after”) the quick reference V T cards were made available in all anesthesia machines in operating rooms of a single academic US medical center. We evaluated the effect of the intervention on the primary outcome while adjusting for previously identified risk factors of large V T use: female gender, obesity (body mass index, BMI > 30), and short height (< 165 cm). The frequency of V T > 10 ml/kg PBW was 15.1% in the before group and 4.3% in the after group (p < 0.001). The frequency of large V T used during abdominal surgery was significantly decreased after the intervention even after adjusting for female gender, obesity or short height [adjOR 0.11 (95% CI 0.04–0.30)]. Our quick reference V T cards significantly reduced the frequency of large V T use during abdominal surgery.

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References

  1. ARDSNet. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301–8.

    Article  Google Scholar 

  2. ARDS Definition Task Force T. Acute respiratory distress syndrome: the Berlin definition. JAMA J Am Med Assoc. 2012;307(23):2526–33.

    Google Scholar 

  3. Cai H, Gong H, Zhang L, Wang Y, Tian Y. Effect of low tidal volume ventilation on atelectasis in patients during general anesthesia: a computed tomographic scan. J Clin Anesth. 2007;19(2):125–9.

    Article  PubMed  Google Scholar 

  4. Futier E, Constantin JM, Paugam-Burtz C, Pascal J, Eurin M, Neuschwander A, Marret E, Beaussier M, Gutton C, Lefrant JY, Allaouchiche B, Verzilli D, Leone M, De Jong A, Bazin JE, Pereira B, Jaber S, Group IS. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. N Engl J Med. 2013;369(5):428–37.

    Article  CAS  PubMed  Google Scholar 

  5. Serpa Neto A, Hemmes SN, Barbas CS, Beiderlinden M, Biehl M, Binnekade JM, Canet J, Fernandez-Bustamante A, Futier E, Gajic O, Hedenstierna G, Hollmann MW, Jaber S, Kozian A, Licker M, Lin WQ, Maslow AD, Memtsoudis SG, Reis Miranda D, Moine P, Ng T, Paparella D, Putensen C, Ranieri M, Scavonetto F, Schilling T, Schmid W, Selmo G, Severgnini P, Sprung J, Sundar S, Talmor D, Treschan T, Unzueta C, Weingarten TN, Wolthuis EK, Wrigge H, Gama de Abreu M, Pelosi P, Schultz MJ, for the PROVE Network Investigators. Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology. 2015;123(1):66–78.

    Article  PubMed  Google Scholar 

  6. Hemmes SN, Serpa Neto A, Schultz MJ. Intraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis. Curr Opin Anaesthesiol. 2013;26(2):126–33.

    Article  PubMed  Google Scholar 

  7. Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Esposito DC, Pasqualucci Mde O, Damasceno MC, Schultz MJ. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651–9.

    Article  CAS  PubMed  Google Scholar 

  8. Lellouche F, Dionne S, Simard S, Bussieres J, Dagenais F. High tidal volumes in mechanically ventilated patients increase organ dysfunction after cardiac surgery. Anesthesiology. 2012;116(5):1072–82.

    Article  PubMed  Google Scholar 

  9. Wolthuis EK, Choi G, Dessing MC, Bresser P, Lutter R, Dzoljic M, van der Poll T, Vroom MB, Hollmann M, Schultz MJ. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents pulmonary inflammation in patients without preexisting lung injury. Anesthesiology. 2008;108(1):46–54.

    Article  PubMed  Google Scholar 

  10. Choi G, Wolthuis EK, Bresser P, Levi M, van der Poll T, Dzoljic M, Vroom MB, Schultz MJ. Mechanical ventilation with lower tidal volumes and positive end-expiratory pressure prevents alveolar coagulation in patients without lung injury. Anesthesiology. 2006;105(4):689–95.

    Article  PubMed  Google Scholar 

  11. Fernandez-Bustamante A, Klawitter J, Repine JE, Agazio A, Janocha AJ, Shah C, Moss M, Douglas IS, Tran ZV, Erzurum SC, Christians U, Seres T. Early effect of tidal volume on lung injury biomarkers in surgical patients with healthy lungs. Anesthesiology. 2014;121(3):469–81.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Guldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM, Rocco PR, Schultz MJ, Pelosi P, Gama de Abreu M. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123(3):692–713.

    Article  PubMed  Google Scholar 

  13. Wanderer JP, Ehrenfeld JM, Epstein RH, Kor DJ, Bartz RR, Fernandez-Bustamante A, Vidal Melo MF, Blum JM. Temporal trends and current practice patterns for intraoperative ventilation at U.S. academic medical centers: a retrospective study. BMC Anesthesiol. 2015;15:40.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Bender SP, Paganelli WC, Gerety LP, Tharp WG, Shanks AM, Housey M, Blank RS, Colquhoun DA, Fernandez-Bustamante A, Jameson LC, Kheterpal S. Intraoperative lung-protective ventilation trends and practice patterns: a report from the multicenter perioperative outcomes group. Anesth Analg. 2015;121(5):1231–9.

    Article  PubMed  Google Scholar 

  15. Ladha K, Vidal Melo MF, McLean DJ, Wanderer JP, Grabitz SD, Kurth T, Eikermann M. Intraoperative protective mechanical ventilation and risk of postoperative respiratory complications: hospital based registry study. BMJ. 2015;351:h3646.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Fernandez-Bustamante A, Wood CL, Tran ZV, Moine P. Intraoperative ventilation: incidence and risk factors for receiving large tidal volumes during general anesthesia. BMC Anesthesiol. 2011;11:22.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Gajic O, Dabbagh O, Park PK, Adesanya A, Chang SY, Hou P, Anderson H 3rd, Hoth JJ, Mikkelsen ME, Gentile NT, Gong MN, Talmor D, Bajwa E, Watkins TR, Festic E, Yilmaz M, Iscimen R, Kaufman DA, Esper AM, Sadikot R, Douglas I, Sevransky J, Malinchoc M. Early identification of patients at risk of acute lung injury: evaluation of lung injury prediction score in a multicenter cohort study. Am J Respir Crit Care Med. 2011;183(4):462–70.

    Article  PubMed  Google Scholar 

  18. Mudumbai SC. Implementation of an anesthesia information management system in an ambulatory surgery center. J Med Syst. 2016;40(1):22.

    Article  PubMed  Google Scholar 

  19. Egger Halbeis CB, Epstein RH, Macario A, Pearl RG, Grunwald Z. Adoption of anesthesia information management systems by academic departments in the United States. Anesth Analg. 2008;107(4):1323–9.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors thank Ken Bullard BS, at the University of Colorado School of Medicine, for his technical assistance.

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Authors and Affiliations

  1. Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, USA

    Chirag K. Shah

  2. Department of Anesthesiology, University of Colorado School of Medicine, 12631 E 17th Ave, AO-1, R2012, MS 8202, Aurora, CO, 80045, USA

    Breandan Sullivan & Ana Fernandez-Bustamante

  3. Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, USA

    Angela Moss & William Henderson

  4. Webb-Waring Center, University of Colorado School of Medicine, Aurora, USA

    Ana Fernandez-Bustamante

Authors
  1. Chirag K. Shah
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  2. Angela Moss
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  3. William Henderson
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  4. Breandan Sullivan
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  5. Ana Fernandez-Bustamante
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Corresponding author

Correspondence to Ana Fernandez-Bustamante.

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Sources of financial support

This work was supported by the 2010 University of Colorado School of Medicine Department of Anesthesiology Seed Grant (2010, AFB), the 2012 Foundation for Anesthesia Education & Research Clinical/Translational-Mentored Research Training Grant [MRTG-CT_2/15/2012_Fernandez-Bustamante (Ana)], and the 2011 Foundation for Anesthesia Education and Research Medical Student Anesthesia Research Fellowship [2011-MSARF-Shah (Chirag)].

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The authors declare no conflicts of interest with this manuscript.

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Shah, C.K., Moss, A., Henderson, W. et al. Quick reference tidal volume cards reduce the incidence of large tidal volumes during surgery. J Anesth 32, 137–142 (2018). https://doi.org/10.1007/s00540-017-2426-z

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  • DOI: https://doi.org/10.1007/s00540-017-2426-z

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