Background: There is a growing concern of the potential injurious role of ventilatory over-distention in patients\r\nwithout lung injury. No formal guidelines exist for intraoperative ventilation settings, but the use of tidal volumes\r\n(VT) under 10 mL/kg predicted body weight (PBW) has been recommended in healthy patients. We explored the\r\nincidence and risk factors for receiving large tidal volumes (VT > 10 mL/kg PBW).\r\nMethods: We performed a cross-sectional analysis of our prospectively collected perioperative electronic database\r\nfor current intraoperative ventilation practices and risk factors for receiving large tidal volumes (VT > 10 mL/kg\r\nPBW). We included all adults undergoing prolonged (= 4 h) elective abdominal surgery and collected\r\ndemographic, preoperative (comorbidities), intraoperative (i.e. ventilatory settings, fluid administration) and\r\npostoperative (outcomes) information. We compared patients receiving exhaled tidal volumes > 10 mL/kg PBW\r\nwith those that received 8-10 or < 8 mL/kg PBW with univariate and logistic regression analyses.\r\nResults: Ventilatory settings were non-uniform in the 429 adults included in the analysis. 17.5% of all patients\r\nreceived VT > 10 mL/kg PBW. 34.0% of all obese patients (body mass index, BMI, = 30), 51% of all patients with a\r\nheight < 165 cm, and 34.6% of all female patients received VT > 10 mL/kg PBW.\r\nConclusions: Ventilation with VT > 10 mL/kg PBW is still common, although poor correlation with PBW suggests it\r\nmay be unintentional. BMI = 30, female gender and height < 165 cm may predispose to receive large tidal\r\nvolumes during general anesthesia. Further awareness of patients� height and PBW is needed to improve\r\nintraoperative ventilation practices. The impact on clinical outcome needs confirmation.
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