Understanding Anesthesia Providers’ Utilization of Lung Protective Ventilation Strategies by Brandon Paluba

Abstract

Purpose: This quality improvement project explored anesthesia providers’ knowledge and utilization of lung-protective ventilation (LPV) strategies in obese patients undergoing laparoscopic surgery at a large urban trauma center.

Background: Obese adults undergoing laparoscopic surgery are at increased risk for postoperative pulmonary complications (PPCs) due to alterations in pulmonary physiology caused by body habitus, Trendelenburg positioning, and abdominal insufflation. PPCs increase morbidity, mortality, hospital length of stay and healthcare costs. Literature demonstrates a reduction in PPCs when LPV strategies are used. It also reveals inconsistent utilization of LPV strategies by anesthesia providers.

Methods: The descriptive design of this project aimed to investigate anesthesia providers’ knowledge and use of LPV strategies in obese patients (BMI > 30kg/m²) undergoing laparoscopic surgery via an anonymous, quantitative electronic survey consisting of 24 Likert-scale questions. A convenience sampling of certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs) was used. The survey was disseminated via e-mail and available by QR code. Responses were organized by the ventilation parameter in question: tidal volume, positive end-expiratory pressure (PEEP), and alveolar recruitment maneuvers (ARMs). Data was evaluated and stratified by role/education, age and years of experience to evaluate for trends.

Results: Fifty-two providers completed the survey. There were significant differences in likelihood to incorporate LPV strategies across groups.

Conclusions: Anesthesia provider utilization of LPV strategies remains inconsistent. Education regarding utilization of evidence-based LPV strategies in obese patients undergoing laparoscopic surgery is warranted.

Keywords: postoperative pulmonary complications, lung-protective ventilation, positive end-expiratory pressure, tidal volume, alveolar recruitment maneuver

Presentation

Biography

Brandon Paluba BSN, SRNA

Brandon Paluba BSN, SRNA is currently enrolled as a Student Registered Nurse Anesthetist (SRNA) in the University of North Carolina at Charlotte/Carolinas Medical Center CRNA DNP program in the class of 2024. Paluba received my Bachelor of Science in Nursing at Gwynedd-Mercy University in Gwynedd Valley, PA in 2012. His background is in Emergency Department and Intensive Care Unit nursing both in Philadelphia, PA and Austin, TX.

Caitlin McConnell BSN, SRNA

Caitlin McConnell BSN, SRNA is currently a student in the CRNA DNP program at the University of North Carolina at Charlotte, and I will be graduating in May of 2024. McConnel is originally from Charlotte, and I obtained a Bachelor of Science in Nursing from Appalachian State University in Boone, North Carolina. After, shen returned to Charlotte where she worked as a nurse in the Cardiac ICU prior to beginning her anesthesia training.

Cameron McClane BSN, SRNA

Cameron McClane BSN, SRNA grew up in Orlando and attended the University of Florida where she received her Bachelor of Science in Nursing. McClane then worked as an ICU nurse in Atlanta before moving to Charlotte to pursue graduate school. She feels fortunate to be in the CRNA DNP program at the University of North Carolina at Charlotte/Carolinas Medical Center and will be graduating in May of 2024.

Faculty Committee Advisor(s)

Stephanie Woods, PhD, RN

Karen Lucisano, PhD, CRNA

Cindy Porras, DNP, CRNA

Shanti Kulkarni, PhD

Katherine Shue-McGuffin, DNP, MSN, APRN, FNP-C