TY - JOUR
T1 - Variability in the use of protective mechanical ventilation during general anesthesia
AU - Ladha, Karim S.
AU - Bateman, Brian T.
AU - Houle, Timothy T.
AU - De Jong, Myrthe A.C.
AU - Vidal Melo, Marcos F.
AU - Huybrechts, Krista F.
AU - Kurth, Tobias
AU - Eikermann, Matthias
N1 - Funding Information:
Funding: B.T.B. is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (Bethesda, MD) under Award Numbers K08HD075831. K.F.H. is supported by a career development grant K01MH099141 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the National Institute of Mental Health. M.F.V.M. is supported by a grant from the National Institute of Health R34 HL123438. Reprints will not be available from the authors. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.anesthesia-analgesia.org). Address correspondence to Matthias Eikermann, MD, PhD, Department of Anesthesiology, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215. Address e-mail to meikerma@bidmc.harvard.edu. Copyright © 2017 International Anesthesia Research Society
Publisher Copyright:
© 2017 International Anesthesia Research Society.
PY - 2018
Y1 - 2018
N2 - BACKGROUND: The purpose of this study was to determine whether significant variation exists in the use of protective ventilation across individual anesthesia providers and whether this difference can be explained by patient, procedure, and provider-related characteristics. METHODS: The cohort consisted of 262 anesthesia providers treating 57,372 patients at a tertiary care hospital between 2007 and 2014. Protective ventilation was defined as a median positive end-expiratory pressure of 5 cm H2O or more, tidal volume of <10 mL/kg of predicted body weight and plateau pressure of <30 cm H2O. Analysis was performed using mixed-effects logistic regression models with propensity scores to adjust for covariates. The definition of protective ventilation was modified in sensitivity analyses. RESULTS: In unadjusted analysis, the mean probability of administering protective ventilation was 53.8% (2.5th percentile of provider 19.9%, 97.5th percentile 80.8%). After adjustment for a large number of covariates, there was little change in the results with a mean probability of 51.1% (2.5th percentile 24.7%, 97.5th percentile 77.2%). The variations persisted when the thresholds for protective ventilation were changed. CONCLUSIONS: There was significant variability across individual anesthesia providers in the use of intraoperative protective mechanical ventilation. Our data suggest that this variability is highly driven by individual preference, rather than patient, procedure, or provider-related characteristics.
AB - BACKGROUND: The purpose of this study was to determine whether significant variation exists in the use of protective ventilation across individual anesthesia providers and whether this difference can be explained by patient, procedure, and provider-related characteristics. METHODS: The cohort consisted of 262 anesthesia providers treating 57,372 patients at a tertiary care hospital between 2007 and 2014. Protective ventilation was defined as a median positive end-expiratory pressure of 5 cm H2O or more, tidal volume of <10 mL/kg of predicted body weight and plateau pressure of <30 cm H2O. Analysis was performed using mixed-effects logistic regression models with propensity scores to adjust for covariates. The definition of protective ventilation was modified in sensitivity analyses. RESULTS: In unadjusted analysis, the mean probability of administering protective ventilation was 53.8% (2.5th percentile of provider 19.9%, 97.5th percentile 80.8%). After adjustment for a large number of covariates, there was little change in the results with a mean probability of 51.1% (2.5th percentile 24.7%, 97.5th percentile 77.2%). The variations persisted when the thresholds for protective ventilation were changed. CONCLUSIONS: There was significant variability across individual anesthesia providers in the use of intraoperative protective mechanical ventilation. Our data suggest that this variability is highly driven by individual preference, rather than patient, procedure, or provider-related characteristics.
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U2 - 10.1213/ANE.0000000000002343
DO - 10.1213/ANE.0000000000002343
M3 - Article
C2 - 28763357
AN - SCOPUS:85045565503
VL - 126
SP - 503
EP - 512
JO - Anesthesia and Analgesia
JF - Anesthesia and Analgesia
SN - 0003-2999
IS - 2
ER -