How traditional and digital analytics interventions can enhance lung-protective ventilation strategies during general anaesthesia: A two-year quality improvement project analysis

PURPOSE

This quality improvement project evaluated interventions implemented to enhance individual adherence to a lung-protective ventilation strategy and its triad: low tidal volume, PEEP ≥ 5, recruitment manoeuvres.

METHODS

For two years, nine anaesthesia workstations were connected to an automated cloud- based analytics software tool, which automatically recorded ventilation parameters as soon as a new patient case was opened. Four quality improvement periods were determined over the first year: baseline, intervention, no intervention, intervention + digital. In the second year, the digital strategy was continued for nine months, followed by a final "overtime" period. Baseline and no intervention periods included no training. The intervention period included both conventional and educational programs. The digital period included pop-up messages, which automatically appeared on the screen of the anaesthesia data management system when patients were intubated. The primary endpoint was provider adherence to the recommended triad.

RESULTS

From October 2018 to December 2020, 12,883 procedures were performed. Data were available for 8,968 procedures: baseline (n = 2361), intervention (n = 2423), no intervention (n = 1064), intervention + digital (n = 1862), overtime (n = 1258). Age, Predicted Body Weight, ASA score, type of surgery and airway management were similar between periods. At baseline, 75.2 % of procedures reported low tidal volume but only 6.9% involved the complete triad. At over time, Triad was 22% (p <  0.001). Over study period, each parameter of the Triad (RM, Vt and Peep) increased (p < 0.001 vs. baseline), driving pressure decreased although EtCO₂ and plateau pressure had not changed.

CONCLUSION

Training with the help of digital apps improved LPV adherence over time.

Incidental Extraspinal Findings in the Thoracic Spine during Magnetic Resonance Imaging of Intervertebral Discs

Objective:

The purpose of this research was to determine the frequency of incidental extraspinal findings in the thoracic spine on magnetic resonance imaging (MRI).

Materials and Methods:

A total of 120 thoracic spine MRI patients were prospectively examined in the period extending from August 2018 to April 2019. Both 1.5 and 0.35 Tesla MRI systems (Toshiba and Siemens Medical system) were applied to investigate patients with suspected intervertebral disc abnormalities at three MRI diagnostic centers in Khartoum, Sudan.

Results:

Out of the 120 patients, incidental extraspinal findings were found in 16 patients (13.3%). Various incidental findings (IFs) were seen, including renal cysts, liver mass, thyroid goiter, and pleural effusion. Out of these IFs, 37.5% were considered clinically significant.

Conclusions:

Various IFs were identified during a routine thoracic spine MRI, and approximately one-third of them were clinically significant. Therefore, it is essential for the reporting radiologists to pay attention to extraspinal findings while reporting thoracic spine MRI to avoid missing clinically significant findings.

Can serum surfactant protein D or CC-chemokine ligand 18 predict outcome of interstitial lung disease in patients with early systemic sclerosis?

OBJECTIVE

To examine the predictive significance of 2 pneumoproteins, surfactant protein D (SP-D) and CC-chemokine ligand 18 (CCL18), for the course of systemic sclerosis (SSc)-related interstitial lung disease.

METHODS

The pneumoproteins were determined in the baseline plasma samples of 266 patients with early SSc enrolled in the GENISOS observational cohort. They also were measured in 83 followup patient samples. Pulmonary function tests were obtained annually. The primary outcome was decline in forced vital capacity (FVC percentage predicted) over time. The predictive significance for longterm change in FVC was investigated by a joint analysis of longitudinal measurements (sequentially obtained FVC percentage predicted) and survival data.

RESULTS

SP-D and CCL18 levels were both higher in patients with SSc than in matched controls (p < 0.001 and p = 0.015, respectively). Baseline SP-D levels correlated with lower concomitantly obtained FVC (r = -0.27, p < 0.001), but did not predict the short-term decline in FVC at 1 year followup visit or its longterm decline rate. CCL18 showed a significant correlation with steeper short-term decline in FVC (p = 0.049), but was not a predictor of its longterm decline rate. Similarly, a composite score of SP-D and CCL18 was a significant predictor of short-term decline in FVC but did not predict its longterm decline rate. Further, the longitudinal change in these 2 pneumoproteins did not correlate with the concomitant percentage change in FVC.

CONCLUSION

SP-D correlated with concomitantly obtained FVC, while CCL18 was a predictor of short-term decline in FVC. However, neither SP-D nor CCL18 was a longterm predictor of FVC course in patients with early SSc.