Percentage of patients undergoing mechanical ventilation in which Positive End Expiratory Pressure (PEEP) is used.

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 and use of PEEP.^1-6 Unfortunately, there is not enough evidence to suggest specific PEEP levels. Therefore, specific threshold indicators will not be defined for PUL 03 initially.

Patient In Room to Patient Out of Room

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

• ASA 5 & 6 cases including Organ Procurement (CPT: 01990)
• Cases in which patients are mechanically ventilated for less than 45 cumulative minutes 
• One-lung ventilation cases (Concept IDs: 50501 & 50202)
• Weight <20kg

Median PEEP ≥ 2 cm H₂O (Assuming values less than 2 cm H₂O is equivalent to no PEEP administered) during ventilation.

• If no weight is recorded, the case is included.
• For a case to be included, there must be at least 45 cumulative minutes of actual tidal volume or 45 minutes of set tidal volume (if actual is not present).
  • For a given case, this measure will exclude periods when patients are not under positive pressure ventilation (as defined by peak inspiratory pressure – positive end expiratory pressure of ≤ 6).
    • Peak Inspiratory Pressure determined by values mapped to MPOG Concept 3185.
    • 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.
• Median PEEP will be determined using values associated with the following variables:
  1. Use Measured PEEP. If not documented,
  2. Use Set PEEP. If not documented,
  3. Determine no PEEP data available.
• PEEP values before case start, after case end, and during periods where PIP - PEEP ≤ 6 are not included in calculating the median.

Distribution of Median PEEP values are reported as follows:

• No PEEP (<2 cm H₂O)
• Low PEEP (2-4 cm H₂O)
• Moderate PEEP (≥ 4 to < 8 cm H₂O)
• High PEEP (≥8 cm H₂O)

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

Departmental only measure - not available for provider feedback emails.

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.