Percentage of patients with median tidal volumes less than or equal to 8 mL/kg.

The use of lung protective ventilation techniques (low tidal volumes and positive end-expiratory pressure) should be part of standard anesthetic practice for most cases that require positive pressure ventilation. Several randomized controlled trials, as well as a meta-analysis in 2015 describe the benefit with low vs high tidal volume techniques.^1-6

Patient In Room to Patient Out of Room

Patients undergoing endotracheal intubation (determined by Anesthesia Technique: General value codes: 1 & 2)

• Age < 12 years
• Age 12-17 years and height <91.4cm (36 in) or >213.4cm (84 in)
• Age ≥ 18 years and height <121.9cm (48 in) OR >213.4cm (84 in)
• ASA 5 & 6 cases including Organ Procurement (CPT: 01990)
• Cases in which patients are mechanically ventilated for less than 45 cumulative minutes 
• Cases where Epoprostenol (Concept ID: 10473) is administered as an inhalational agent
• Cases without a documented height
• Cases without a documented sex
• One-lung ventilation cases (Concept IDs: 50501 & 50202)
• Weight < 20kg

Intraoperative median tidal volume ≤ 8 ml/ kg predicted body weight

• For a given case, this measure will exclude periods when patients are not under positive pressure ventilation (coded in the measure to exclude minutes where Peak Inspiratory Pressure – PEEP </= 6).
  • Peak Inspiratory Pressure determined by values mapped to MPOG Concept 3185. If no PIP documented, PIP is considered null and tidal volume is included.
  • PEEP will be determined using values associated with the following variables:
    1.  Use Measured PEEP (MPOG Concept: 3210). If not documented,
    2.  Use Set PEEP (MPOG Concept: 3212). If not documented,
    3.  Assume PEEP = 0.
• For a case to be included for the PUL-02 measure, it must have at least 45 valid values of actual tidal volume or set tidal volume
• In determining median tidal volume, if any value greater than two (2) is documented, it is assumed that tidal volume is documented in milliliters (mL). If all values are less than two (2), tidal volume is assumed to be measured in liters (L).
• For patients ≥18 years old with height>121.9cm (48 in) but <213.4cm (84 in), the following equation is used to determine Predicted Body Weight. For patients >121.9 cm (48 in) but < 152.4 cm (60 in): 5 feet (152.4 cm) will be used for the IBW formula.
  • Male patients: 50kg + 0.91kg * (height in cm - 152.4)
  • Female patients: 45.5kg + 0.91kg * (height in cm - 152.4)
• For patients 12-17 years old and height > 91.4cm (36 in) but <213.4cm (84 in), the McLaren Method is used to determine Predicted Body Weight. The McLaren Method is the most commonly used method to determine PBW in children and uses growth charts to determine IBW by identifying the 50^th percentile height for age, then using that height to determine 50^th percentile weight. This weight is the patient’s Predicted Body Weight (PBW).⁷
• “Actual tidal volume” trumps “set tidal volume” if there are at least 45 valid “actual tidal volume” measurements. If there are no values for “actual tidal volume”, “set tidal volume” is used. Reference Ventilation During Intraop for more details.

Algorithm for determining Measure Start/End Times:

• Start
  • Patient In Room. If not available, then
  • Induction End. If not available, then
  • Anesthesia Start
•  End
  • Patient out of room. If not available, then
  • Anesthesia End

*This measure will include valid MPOG cases defined by the Is Valid Case phenotype.

Not applicable

Primary Provider - Provider(s) present for longest duration of the case per staff role. 

In the event that two or more providers in the same class are signed in for the same duration, all providers signed in for the longest duration will be attributed.

1. Brower RG, Matthay MA, Morris A, Schoenfeld D, Thompson BT, Wheeler A. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The New England journal of medicine. 2000;342(18):1301-1308.
2. Fernandez-Perez ER, Keegan MT, Brown DR, Hubmayr RD, Gajic O. Intraoperative tidal volume as a risk factor for respiratory failure after pneumonectomy. Anesthesiology. 2006;105(1):14-18.
3. Futier E, Constantin JM, Paugam-Burtz C, et al. A trial of intraoperative low-tidal-volume ventilation in abdominal surgery. The New England journal of medicine. 2013;369(5):428-437.
4. Guldner A, Kiss T, Serpa Neto A, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123(3):692-713.
5. Kang K, Absher R, Farrington E, Ackley R, So TY. Evaluation of Different Methods Used to Calculate Ideal Body Weight in the Pediatric Population. J Pediatr Pharmacol Ther. 2019 Sep-Oct;24(5):421-430. doi: 10.5863/1551-6776-24.5.421. PMID: 31598106; PMCID: PMC6782117.
6. Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus Conventional Ventilation for Surgery: A Systematic Review and Individual Patient Data Meta-analysis. Anesthesiology. 2015;123(1):66-78.
7. Severgnini P, Selmo G, Lanza C, et al. Protective mechanical ventilation during general anesthesia for open abdominal surgery improves postoperative pulmonary function. Anesthesiology. 2013;118(6):1307-1321.
8. Phillips S, Edlbeck A, Kirby M, Goday P. Ideal body weight in children. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2007;22(2):240-245.