Ventilation Strategy During General Anesthesia for Orthopedic Surgery: A Quality Improvement Project
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Orthopedic Surgery
- Sponsor
- The Cleveland Clinic
- Enrollment
- 2860
- Locations
- 1
- Primary Endpoint
- Time-weighted Average SaO2/FiO2 Ratio in the Postanesthesia Care Unit (PACU)
- Status
- Completed
- Last Updated
- 8 months ago
Overview
Brief Summary
The objective is to determine the optimal intraoperative ventilation strategy among the chosen tidal volume and positive end-expiratory pressure (PEEP) levels, and standardize it in an enhanced recovery pathway for orthopedic surgical patients. In particular, we propose to determine which combination of intraoperative tidal volume and positive end-expiratory pressure is best for patients having elective orthopedic surgery.
Detailed Description
This is a non-randomized alternating intervention cohort study in which all orthopedic surgery operating rooms will alternate amongst four designated ventilation settings which include two tidal volumes and two PEEP levels. At the end of the four-week sequence, the entire sequence will be repeated 26 times over a 2-year period. Thus, ventilator settings will not be randomized on a per-patient basis, or even among study weeks. Ventilation parameters will be designated at the beginning of each study week. However, clinicians will be free to adjust to whatever ventilation settings they believe is optimal in individual patients to ensure oxygenation and patient safety.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Surgery in orthopedic operating rooms 32-37
- •General anesthesia with endotracheal intubation.
Exclusion Criteria
- •Non-orthopedic procedures;
- •Intubation before induction of anesthesia.
Outcomes
Primary Outcomes
Time-weighted Average SaO2/FiO2 Ratio in the Postanesthesia Care Unit (PACU)
Time Frame: After surgery until discharged from PACU or up to 90 minutes
Primary outcome was oxygenation in the postoperative care unit, defined by the peripheral oxygen saturation divided by the fraction of inspired oxygen (SpO2/FiO2 ratio), a validated measure of acute lung injury.
Secondary Outcomes
- Composite of Serious Postoperative Pulmonary Complications(After surgery from 2 to 5 days)
- Oxygenation in Ward, Defined as Time Weighted Average (TWA) of SaO2/FIO2 Ratio(After surgery from 2 to 5 days)
- Length of Postoperative Hospital Stay by Days(from out of operation room to discharge)