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Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol.

Publication ,  Journal Article
Trethewey, BN; Bukowy, BM; Bodnar, SJ; Migliarese, JE; Falyar, CR; Harris, EM; Simmons, VC; Silva, SG
Published in: AANA journal
October 2021

The clinical application of intraoperative mechanical ventilation is highly variable and often determined by providers' attitudes and preferences, rather than evidence. Ventilation strategies using high tidal volumes (VT) with little to no positive end-expiratory pressure (PEEP) are associated with lung injury, increasing the risk of postoperative pulmonary complications. Literature demonstrates that applying lung protective ventilation (LPV) strategies intraoperatively, including low VT, individualized PEEP, and alveolar recruitment maneuvers, can reduce the risk of postoperative pulmonary complications. This multicenter quality improvement project aimed to develop and implement an LPV protocol to increase nurse anesthetists' knowledge and adherence to LPV strategies in adults undergoing laparoscopic cholecystectomy. The anesthesia providers were educated about LPV strategies and their intraoperative application to individualize ventilation settings based on patient comorbidities and body habitus. Adherence was determined by collecting ventilator data and evaluating the data using logistic regression. The overall protocol adherence significantly increased (P=.01). Additionally, there was a significant improvement in adherence to each individual component of the protocol (all P<.05) except for VT. Decreasing the oxygen concentration administered during maintenance and emergence was the most commonly adopted practice (P<.0001). This project demonstrates that education and a standardized protocol can increase the use of intraoperative LPV strategies.

Duke Scholars

Published In

AANA journal

EISSN

2162-5239

ISSN

0094-6354

Publication Date

October 2021

Volume

89

Issue

5

Start / End Page

419 / 427

Related Subject Headings

  • Tidal Volume
  • Respiration, Artificial
  • Postoperative Complications
  • Positive-Pressure Respiration
  • Nurse Anesthetists
  • Lung
  • Humans
  • Anesthesiology
  • Adult
  • 1110 Nursing
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Trethewey, B. N., Bukowy, B. M., Bodnar, S. J., Migliarese, J. E., Falyar, C. R., Harris, E. M., … Silva, S. G. (2021). Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol. AANA Journal, 89(5), 419–427.
Trethewey, Brittany N., Brooks M. Bukowy, Stephan J. Bodnar, Jaclyn E. Migliarese, Christian R. Falyar, Erica M. Harris, Virginia C. Simmons, and Susan G. Silva. “Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol.AANA Journal 89, no. 5 (October 2021): 419–27.
Trethewey BN, Bukowy BM, Bodnar SJ, Migliarese JE, Falyar CR, Harris EM, et al. Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol. AANA journal. 2021 Oct;89(5):419–27.
Trethewey, Brittany N., et al. “Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol.AANA Journal, vol. 89, no. 5, Oct. 2021, pp. 419–27.
Trethewey BN, Bukowy BM, Bodnar SJ, Migliarese JE, Falyar CR, Harris EM, Simmons VC, Silva SG. Certified Registered Nurse Anesthetists' Adherence to an Intraoperative Lung Protective Ventilation Protocol. AANA journal. 2021 Oct;89(5):419–427.

Published In

AANA journal

EISSN

2162-5239

ISSN

0094-6354

Publication Date

October 2021

Volume

89

Issue

5

Start / End Page

419 / 427

Related Subject Headings

  • Tidal Volume
  • Respiration, Artificial
  • Postoperative Complications
  • Positive-Pressure Respiration
  • Nurse Anesthetists
  • Lung
  • Humans
  • Anesthesiology
  • Adult
  • 1110 Nursing