Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia

BMC Anesthesiology

Dharshi Karalapillai¹⁰  Laurence Weinberg¹⁰  Jonathan Galtieri⁴  Neil Glassford²  Glenn Eastwood²  Jai Darvall⁴  Jake Geertsema⁵  Ravi Bangia⁹  Jane Fitzgerald³  Tuong Phan⁸  Luke OHallaran⁷  Adriano Cocciante¹  Stuart Watson¹  David Story¹¹  Rinaldo Bellomo⁶ 

[1] Department of Anaesthesia, Western Health, Melbourne, Australia

[2] Department of Intensive Care, Austin Hospital, Melbourne, Australia

[3] Department of Anaesthesia, Alfred Hospital, Melbourne, Australia

[4] Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia

[5] Department of Anaesthesia, Northern Hospital, Melbourne, Australia

[6] Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

[7] Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia

[8] Department of Anaesthesia, St Vincents Hospital, Melbourne, Australia

[9] Department of Anaesthesia, Box Hill Hospital, Melbourne, Australia

[10] Department of Anaesthesia, Austin Hospital, Melbourne, Australia

[11] University of Melbourne, Melbourne, Australia

关键词: Anaesthesia;    Intraoperative ventilation;    PEEP;    Tidal volume;   

Others  :  1084377
DOI  :  10.1186/1471-2253-14-85

 received in 2014-05-13, accepted in 2014-09-11,  发布年份 2014

【 摘 要 】

Background

Recent evidence suggests that the use of low tidal volume ventilation with the application of positive end-expiratory pressure (PEEP) may benefit patients at risk of respiratory complications during general anaesthesia. However current Australian practice in this area is unknown.

Methods

To describe current practice of intraoperative ventilation with regard to tidal volume and application of PEEP, we performed a multicentre audit in patients undergoing general anaesthesia across eight teaching hospitals in Melbourne, Australia.

Results

We obtained information including demographic characteristics, type of surgery, tidal volume and the use of PEEP in a consecutive cohort of 272 patients. The median age was 56 (IQR 42–69) years; 150 (55%) were male. Most common diagnostic groups were general surgery (31%), orthopaedic surgery (20%) and neurosurgery (9.6%). Mean FiO₂ was 0.6 (IQR 0.5-0.7). Median tidal volume was 500 ml (IQR 450-550). PEEP was used in 54% of patients with a median value of 5.0 cmH₂O (IQR 4.0-5.0) and median tidal volume corrected for predicted body weight was 9.5 ml/kg (IQR 8.5-10.4). Median peak inspiratory pressure was 18 cmH₂O (IQR 15–22). In a cohort of patients considered at risk for respiratory complications, the median tidal volume was still 9.8 ml/kg (IQR 8.6-10.7) and PEEP was applied in 66% of patients with a median value of 5 cmH₂0 (IQR 4–5). On multivariate analyses positive predictors of tidal volume size included male sex (p < 0.01), height (p = 0.04) and weight (p < 0.001). Positive predictors of the use of PEEP included surgery in a tertiary hospital (OR = 3.11; 95% CI: 1.05 to 9.23) and expected prolonged duration of surgery (OR = 2.47; 95% CI: 1.04 to 5.84).

Conclusion

In mechanically ventilated patients under general anaesthesia, tidal volume was high and PEEP was applied to the majority of patients, but at modest levels. The findings of our study suggest that the control groups of previous randomized controlled trials do not closely reflect the practice of mechanical ventilation in Australia.

【 授权许可】

   
2014 Karalapillai et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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