Assessing Provider Adherence To A Lung Protective Ventilation Protocol In Patients Undergoing Thoracic Surgery Using...

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Critical Care Medicine

Background:

• One-lung ventilation (OLV) poses a risk of lung injury and postoperative pulmonary complications (PPCs).
• Lung protective ventilation (LPV) strategies, including low tidal volumes, individualized PEEP, and recruitment maneuvers, aim to mitigate this risk.
• Reducing driving pressure is a key mechanism for LPV to decrease PPCs.

Purpose of the Study:

• To assess the impact of an educational intervention and cognitive aids on provider knowledge and adherence to an LPV protocol during OLV.
• To evaluate the effect of LPV protocol implementation on clinical practice and patient outcomes.

Main Methods:

• An LPV protocol was developed and implemented for patients undergoing OLV.
• Provider knowledge and confidence were assessed pre- and post-intervention.
• Clinical data, including adherence to LPV components (tidal volume, PEEP, RM, FiO2) and driving pressure, were collected before and after protocol implementation.

Main Results:

• Provider knowledge regarding LPV significantly increased (P = .015).
• Adherence to monitoring driving pressures significantly improved at 12 weeks post-implementation (P < .05).
• While overall adherence to LPV components showed an increasing trend (P = .356), a statistically significant decrease in driving pressure was observed (P < 0.05).

Conclusions:

• Implementation of an LPV protocol enhances provider knowledge and adherence to lung-protective strategies during OLV.
• The reduction in driving pressure achieved through LPV implementation is associated with decreased postoperative pulmonary complications in thoracic surgery.
• This study highlights the effectiveness of structured protocols and education in improving LPV adoption and patient safety.