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

BMC Anesthesiology

Research Article

Jane Fitzgerald¹  Laurence Weinberg²  Ravi Bangia³  Luke OHallaran⁴  Jake Geertsema⁵  Tuong Phan⁶  Adriano Cocciante⁷  Stuart Watson⁷  Jai Darvall⁸  Jonathan Galtieri⁸  Glenn Eastwood⁹  Neil Glassford⁹  Dharshi Karalapillai^1,10  Rinaldo Bellomo^1,11  David Story^1,12 

[1] Department of Anaesthesia, Alfred Hospital, Melbourne, Australia;Department of Anaesthesia, Austin Hospital, Melbourne, Australia;Department of Anaesthesia, Box Hill Hospital, Melbourne, Australia;Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia;Department of Anaesthesia, Northern Hospital, Melbourne, Australia;Department of Anaesthesia, St Vincents Hospital, Melbourne, Australia;Department of Anaesthesia, Western Health, Melbourne, Australia;Department of Anesthesia, Royal Melbourne Hospital, Melbourne, Australia;Department of Intensive Care, Austin Hospital, Melbourne, Australia;Department of Intensive Care, Austin Hospital, Melbourne, Australia;Department of Anaesthesia, Austin Hospital, Melbourne, Australia;Intensive Care Research, Austin Hospital and Co-director, Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), Melbourne, Australia;Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia;University of Melbourne, Melbourne, Australia;

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

DOI  :  10.1186/1471-2253-14-85

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

来源: Springer

【 摘 要 】

BackgroundRecent 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.MethodsTo 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.ResultsWe 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).ConclusionIn 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】

CC BY   
© Karalapillai et al.; licensee BioMed Central Ltd. 2014