Improving Adherence to Intraoperative Lung-Protective Ventilation Strategies Using Near Real-Time Feedback and...

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Health Informatics

Background:

• Postoperative pulmonary complications significantly impact surgical patient morbidity and mortality.
• Intraoperative lung protective ventilation (LPV) using low tidal volume and PEEP reduces pulmonary injury and infection.
• Optimizing anesthesiologist adherence to LPV strategies is crucial for patient outcomes.

Purpose of the Study:

• To develop decision support systems (DSS) aimed at enhancing anesthesiologist adherence to intraoperative lung-protective ventilation (LPV) strategies.
• To evaluate the effectiveness of different DSS interventions on LPV adherence.
• To assess the sustainability of behavioral changes induced by DSS.

Main Methods:

• A 4-year study involving 49,386 procedures and 109 attendings.
• LPV defined as tidal volume (TV) of 6-8 mL/kg ideal body weight and PEEP ≥4 cm H2O.
• Four intervention phases: education, near real-time feedback, individualized post hoc feedback, and enhanced multidimensional DSS.
• Segmented logistic regression with generalized estimating equations analyzed temporal trends and intervention effects.

Main Results:

• Baseline LPV adherence was 45.2%.
• Education improved adherence by 8.7% (OR=1.16).
• Near real-time feedback increased adherence by 15.5% (OR=1.69).
• Individualized dashboards combined with feedback showed an 18.1% increase (OR=2.23).
• Adherence improvements were sustained for over 24 months.

Conclusions:

• Near real-time and post hoc reporting facilitate sustained behavioral changes in adopting evidence-based clinical strategies.
• DSS, particularly near real-time feedback and individualized dashboards, significantly improve and sustain adherence to LPV.
• This study demonstrates a successful approach to overcoming the transient effects often seen with decision support solutions.