Quick reference tidal volume cards reduce the incidence of large tidal volumes during surgery.

Abstract

Ventilation with large tidal volumes (V T), greater than 10ml/kg of predicted body weight (PBW), is associated with worse outcomes in critically ill and surgical patients. We hypothesized that the availability of quick reference cards with proposed V T ranges specific to gender and different heights would reduce the intraoperative use of large V T during prolonged abdominal surgery. We compared retrospectively the incidence of median V T used during prolonged (≥4-h-long) abdominal surgery before ("before") and after ("after") the quick reference V T cards were made available in all anesthesia machines in operating rooms of a single academic US medical center. We evaluated the effect of the intervention on the primary outcome while adjusting for previously identified risk factors of large V T use: female gender, obesity (body mass index, BMI>30), and short height (<165cm). The frequency of V T>10ml/kg PBW was 15.1% in the before group and 4.3% in the after group (p<0.001). The frequency of large V T used during abdominal surgery was significantly decreased after the intervention even after adjusting for female gender, obesity or short height [adjOR 0.11 (95% CI 0.04-0.30)]. Our quick reference V T cards significantly reduced the frequency of large V T use during abdominal surgery.