Implementation of a reference card to improve anesthesia provider use of lung protective tidal volumes in patients with obesity undergoing general endotracheal anesthesia

Purpose:The rising rate of obesity in the United States is paralleled by a growing number of patients with obesity undergoing anesthesia. Patients with obesity face an increased risk of postoperative pulmonary complications and present unique challenges to anesthesia providers. Randomized controlled trials and expert consensus supports the use of intraoperative lung protective ventilation (LPV), including tidal volumes (TV) of 6-8 ml/kg based on predicted body weight (PBW), to help decrease risks that obese patients face from surgery and anesthesia. Methodology:Quality improvement study on the use of a tidal volume reference card as a point of care nudge intervention using retrospective chart review of randomly sampled eligible cases. Results:Implementing the reference card led to a decrease in average TV/PBW from 9.5 ml/kg PBW to 8.4 ml/kg PBW (p = .001), showing a significant trend towards the recommended range. The reference card effectively improved clinical decision-making. Patients were still consistently overventilated with higher than suggested tidal volumes, with females being more excessively overventilated. Implications For Practice:Continued education and improved clinical application of lung protective ventilation is imperative to provide the best evidence-based care for obese individuals undergoing surgery and anesthesia.D.N.P.Includes bibliographical reference