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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Dharshi Karalapillai, Laurence Weinberg, Jonathan Galtieri, Neil Glassford, Glenn Eastwood, Jai Darvall, Jake Geertsema, Ravi Bangia, Jane Fitzgerald, Tuong Phan, Luke OHallaran, Adriano Cocciante, Stuart Watson, David Story, Rinaldo Bellomo

Published in: BMC Anesthesiology | Issue 1/2014

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Abstract

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.
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Metadata
Title
Current ventilation practice during general anaesthesia: a prospective audit in Melbourne, Australia
Authors
Dharshi Karalapillai
Laurence Weinberg
Jonathan Galtieri
Neil Glassford
Glenn Eastwood
Jai Darvall
Jake Geertsema
Ravi Bangia
Jane Fitzgerald
Tuong Phan
Luke OHallaran
Adriano Cocciante
Stuart Watson
David Story
Rinaldo Bellomo
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2014
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-14-85

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