The mandatory educational module increases the effect of implementing the standard operating procedure and adherence...

Adherence to lung-protective ventilation leads to a lower incidence of perioperative pulmonary complications. However, adherence is reported to be only approximately 15% worldwide. Therefore, we conducted a prospective interventional clinical pre-post study to assess the impact of a standardized operating procedure (SOP) enhanced with a mandatory educational programme on adherence to intraoperative lung protective ventilation (IOLPV).

First, we assessed the current level of adherence to the IOLPV concept (Group A - before SOP). Thereafter, we implemented the SOP enhanced with a mandatory educational programme. When the program finished, our team assessed the new adherence level to the LPV concept (Group B - after SOP). We compared the number of cases that abided by each IOLPV recommendation and the number of cases that abided by the whole IOLPV bundle between the groups.

A total of 164 patients were enrolled (Group A 82, Group B 82) in the study. The number of procedures with adherence to the whole IOLPV bundle was significantly greater in Group B (Group A, 4%; Group B, 24%; p < 0.001). Similarly, the total number of recruitment manoeuvres performed was significantly greater in Group B than in Group A (Group A 11, Group B 35, p < 0.001). The mean positive end-expiratory pressure (PEEP) was likewise significantly greater in Group B than in Group A (Group A, 6.6 ± 1.88 mbar; Group B, 7.8 ± 2.10 mbar; p < 0.001), leading to significantly more cases with an abiding level of PEEP, as recommended in Group B, than in Group A (Group A, 22; Group B, 49; p < 0.001). There was no significant difference between the groups in terms of the number of cases that abided by the plateau, the driving pressure, the tidal volume, or the breathing frequency.

The SOP enhanced with a mandatory educational program focused on IOLPV may be an effective tool for increasing adherence to IOLPV in daily practice.

The study has been preregistered in registry clinicaltrials.gov and assigned the study registration number NCT05831683 with the brief title "Standard Operating Procedure as a Valuable Tool to Increase Adherence to Lung Protective Ventilation among Anaesthesiologists". Initial release on 3.4.2023 accessible on link https://clinicaltrials.gov/study/NCT05831683 .