Résumé
This quality improvement project evaluated interventions to enhance individual adherence to lung protective ventilation (LPV) strategy and its triad: low tidal volume (6 to 8 mL/Kg of Predicted Body Weight (PBW), Positive-end expiratory pressure (PEEP) ≥5 cmH2O and recruitment maneuvers.Methods: for two years, nine anesthesia workstations were connected an automated cloud based analytics software that automatically recorded ventilation parameters as soon as a new patient case was opened. Over the first year, four consecutive periods were determined: baseline, intervention, no intervention, intervention+digital. During the second year, digital was continued for nine months, followed by a last period: “overtime”. Baseline and no intervention periods were absence of any education. Intervention included educational and conventional program. For procedure, digital included pop-up messages that automatically appeared on the screen of anesthesia information management system when patient intubation was informed. Recording times during each period were blinded. Primary endpoint was provider adherence to the recommended triad. Results: from October 2018 to December 2020, 12 883 procedures were enrolled. Data were available for 8 968 procedures: baseline (n=2 361), intervention (n=2 423), no intervention (n=1 064), intervention+digital (n=1 862), over time (n=1 258). Age, Predicted Body Weight, ASA score, type of surgery, duration of general anesthesia, airway management were similar between periods. At baseline, 71% procedures reported low tidal volume but only 7% involved the complete triad. These parameters were significantly increased during intervention+digital (respectively, 79% and 27%) and overtime (respectively, 91% and 21%). The plateau pressure increased significatively over periods compared to baseline, but was always under or equal to 15 cmH2O, while the driving pressure decreased more significatively (p<0.01). Mortality over periods did not change.Conclusion: low tidal volume is well practiced but application of the whole recommended LPV triad was limited. Triad use can be easily improved by education but maintaining adherance over time is challenging. This study highlights the help of digital and record apps.