CRNA Perception and Implementation of Lung Protective Ventilation

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)

Paige Morrison (Creator)

Institution

The University of North Carolina at Greensboro (UNCG )

Web Site: http://library.uncg.edu/

Advisor

Terry Wicks

Abstract: Background General anesthesia causes the collapse of the alveoli, known as (atelectasis) in roughly 90% of anesthetized patients. Postoperative atelectasis may persist for several hours to days and significantly increases the risk for postoperative pulmonary complications (PPCs) and morbidity and mortality. Atelectasis and PPCs can be prevented by the use of lung protective ventilation (LPV). LPV is a ventilatory strategy that is designed to recover the aeration of the lung. LPV includes low tidal volumes (Vt), utilization of positive end-expiratory pressures (PEEP), application of low driving pressures, and use of alveolar recruitment maneuvers (ARMs). Purpose The goal of this DNP project is to provide practicing CRNAs with a concise recommendation for standardizing LPV implementation into practice. An investigation of the current attitudes and knowledge regarding the topic was performed. Additionally, this project discovered barriers preventing CRNAs from implementing LPV into clinical practice.Methods A brief questionnaire investigating attitudes and knowledge regarding the topic was administered pre- and post-intervention. We anticipated that after an educational intervention, practicing CRNAs will have the appropriate comfort and knowledge to implement lung protective ventilation into their daily practice. Following the educational presentation, the same survey was distributed to the participants to see if or how their answers and practice had changed. Results Five of the participants indicated that he or she use the compliance and PV loops on the ventilator, two of which began following the educational intervention. Also, all participants reported on the pre-intervention surveys that they currently use some form of LPV. The surveys varied in responses on what prompts the provider to perform ARMs. None of the participants indicated why or if they are reluctant to implement all aspects of LPV into their current practice following the educational intervention. Recommendations and Conclusions Currently, many anesthesia providers implement one or more aspects of LPV currently in practice. However, the method of determining the optimum level of PEEP, and the most effective method of performing recruitment maneuvers remains unclear.

CRNA Perception and Implementation of Lung Protective Ventilation
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Created on 2/14/2023
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Additional Information

Publication

Dissertation

Language: English

Date: 2022

Keywords

Lung Protective Ventilation, LPV, protective lung ventilation, low-tidal volume, positive-end-expiratory pressure , PEEP, alveolar recruitment maneuvers, ARMS, vital capacity breaths, atelectasis, postoperative pulmonary complications, PPCs

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