Intra-operative adherence to lung-protective ventilation: a prospective observational study

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Respiratory Medicine

Background:

• Lung-protective ventilation (LPV) improves mortality in acute respiratory distress syndrome.
• Perioperative LPV reduces inflammation and complications in major abdominal surgery.
• This study assessed intra-operative ventilation practices in the West Midlands.

Purpose of the Study:

• To evaluate the current use of lung-protective ventilation during surgery in the West Midlands.
• To identify barriers to the adoption of lung-protective ventilation in the perioperative setting.

Main Methods:

• Prospective observational study of adult ventilated patients across 14 hospital trusts.
• Data collected on ventilatory parameters, patient demographics, and surgical details over a 2-day period.
• LPV defined by tidal volume (6-8 ml/kg/PBW), peak pressure (<30 cmH2O), and PEEP (6-8 cmH2O).

Main Results:

• 406 patients included; 78% elective surgery, predominantly general, trauma, and orthopedic.
• Volume-controlled ventilation used in 70% of cases; no patients received LPV.
• Low peak airway pressure (median 20 cmH2O), tidal volumes of 8.4 ml/kg/PBW, and low PEEP (median 4 cmH2O); PEEP unused in 152 cases.

Conclusions:

• Perioperative LPV can enhance patient outcomes in major surgery.
• Intra-operative LPV is uncommon in the West Midlands, particularly PEEP use.
• Further research and trials are recommended to encourage wider adoption of LPV practices.