Improving Certified Registered Nurse Anesthetists’ Adherence to a Standardized Intraoperative Lung Protective Ventilation Protocol

Abstract

The use of lung protective ventilation (LPV) during general anesthesia is an effective strategy among certified registered nurse anesthetists (CRNAs) to reduce and prevent the incidence of postoperative pulmonary complications. The purpose of this project was to implement a LPV protocol, assess CRNA provider adherence, and investigate differences in ventilation parameters and postoperative oxygen requirements. This quality improvement project was conducted using a pre- and postimplementation design. Sixty patients undergoing robotic laparoscopic abdominal surgery and 35 CRNAs at a community hospital participated. An evidence-based intraoperative LPV protocol was developed, CRNA education was provided, and the protocol was implemented. Pre- and postimplementation, CRNA knowledge, and confidence were assessed. Ventilation data were collected at 1-minute intervals intraoperatively and oxygen requirements were recorded in the postanesthesia care unit (PACU). Use of intraoperative LPV strategies increased 2.4%. Overall CRNA knowledge (P=.588), confidence (P=.031), and practice (P < .001) improved from pre- to postimplementation. Driving pressures decreased from pre- to postimplementation (P < .001). Supplemental oxygen use on admission to the PACU decreased from 93.3% to 70.0%. Educational interventions and implementation of a standardized protocol can improve the use of intraoperative LPV strategies and patient outcomes.