MPOG Pediatric
Subcommittee Meeting
May 18, 2022
Agenda
10 minutes
Announcements
Dr. Bishr Haydar, University of Michigan
20 minutes
Peds Sustainability Workgroup Update
Dr. Eva Lu-Boettcher, University of Wisconsin
30 minutes
Unblinded Data Review
Dr. Nirav Shah, MPOG QI Director
QI Toolkits Available
• Designed to improve care and patient
outcomes through the adoption of best
practices.
• Contain a collection of educational
resources, articles, and reference guides.
• Opportunity for pediatric subcommittee
members!
– Building pediatric specific toolkits
– Update/revise existing toolkit based on
recent literature
– Great avenue to produce scholarly
work
Reference Guides
Educational Presentations
NEW! Pediatric Measures
Transfusion Vigilance, Pediatrics (TRAN-03)
Overtransfusion, Pediatrics (TRAN-04)
*Inverse measure. Lower score = better performance
Neuromuscular Blockade Dosing, Children (NMB-03)
Sustainable Pediatric
Anesthesia
Dr. Eva Lu-Boettcher, University of Wisconsin
MPOG Measure Build: Sustainability
Active:
• SUS-01: Low Fresh Gas Flow ≤ 3L/min
In Progress:
• SUS-02: Global warming footprint of inhalational agents (maintenance)
• SUS-03: Global warming footprint of inhalational agents (induction)
• SUS-04: Low Fresh Gas Flow ≤ 2L/min
SUS-01: Low Fresh Gas Flow ≤ 3L/min (Active)
■ Measure Time Period: Intubation → Extubation
■ Inclusions: Patients who receive halogenated agents and/or nitrous oxide for ≥
30 minutes
■ Exclusions:
– Cases with >20% of Fresh Gas Flow values manually entered during the case (automated
capture of FGF required)
– Cases in which nitric oxide is administered.
■ Artifact Values
– Nitrous Oxide Flows: <0.2 L/min
– Isoflurane Insp: <0.2%
– Sevoflurane Insp: <0.5%
– Desflurane Insp: <0.5%
– Nitrous Oxide Insp: <15%
SUS-04: Low Fresh Gas Flow ≤ 2L/min (In Progress)
■ Measure Time Period: Intubation → Extubation
■ Inclusions: Patients who receive halogenated agents and/or
nitrous oxide for ≥ 30 minutes
■ Exclusions:
– Cases with >20% of Fresh Gas Flow values manually entered during the
case (automated capture of FGF required)
– Cases in which nitric oxide is administered.
Global Warming Footprint of Inhalational Agents (In Progress)
SUS-02: Maintenance
Measure Type: Process (90%)
Time Period: Intubation → Extubation
Provider(s) Notified: signed in for at least
30 minutes during the time when halogenated
agent or nitrous oxide are documented.
SUS-03: Induction
Measure Type: Informational
Time Period: Induction Start → Induction End
Provider(s) Notified: None
Percentage of cases where carbon dioxide equivalents, normalized by hour, is less than carbon dioxide
equivalents of 2% sevoflurane at 2L FGF = 2.58 kg CO2/hr
How are CO2 Equivalents Derived?
Number of minutes of
inhalational agent
administered.
● Convert agent % and FGF → mass of agent (mols/min)
● For Nitrous %
a. Convert Nitrous % and FGF → Nitrous Flows (L/min)
b. N2O flow → mass of agent (mols/min)
Agent Molecular
Weight
(g/mol)
Global
Warming
Potential
100
Atmospheric
Lifetime (years)
Isoflurane 184.5 565 3.2
Sevoflurane 200 144 1.1
Desflurane 169 2720 14
Nitrous Oxide 44 282* 114
⅀ [Inspired agent (%) × Fresh Gas Flow (L/min)]
1-n
x GWP
100
Pediatric Sustainability Measure Proposals
Q: Do MPOG sustainability metric specifications accurately apply to the pediatric
population?
○ Topics addressed:
i. Unique aspects of induction that would warrant peds specific
metrics?
ii. Include or exclude short cases < 30min?
Pediatric Sustainability Measure Proposals
Workgroup Summary:
● Pediatric-Specific Induction Metrics:
○ SUS-05-PEDS: Weight-based FGF during induction:
i. Mask Inductions
ii. TIVA
○ SUS 06-PEDS: N2O (yes/no) used during induction.
○ SUS-Peds Age Definition: < 12y or < 18y?
i. Mask versus IV induction cut off.
Pediatric Sustainability Measure Proposals
Workgroup Summary Cont:
● Include or exclude short cases <30min?
○ Excluding cases < 30 min will throw a lot of pediatric cases out. Recommend
including all cases regardless of duration.
Unblinded Data Review
Nirav Shah, MPOG QI Director
Reminders
• As outlined during the registration process:
– A culture of openness and trust is critical to improve quality; and a commitment for confidentiality
is required for unblinded data at MPOG QI
– The following examples are to be considered privileged and confidential information and should be
discussed only within the confines of the Pediatric Subcommittee Meeting.
– Any and all patient information.
– Any and all patient identifiers/information which are considered privileged and protected
health information as defined by current HIPAA laws.
– Any specific MPOG QI registry case information.
– Any information discussed regarding a specific site outcome.
– Any reference to a specific MPOG site result or analysis.
– All anesthesiology data presented including but not limited to outcome reports
• Taking screenshots, pictures or videos of data slides is prohibited
Site Participation
• All sites that perform > 2,000 pediatric cases/year are included on the slides to
follow
• MPOG Quality Champions were notified that unblinded data would be shared and
were given the opportunity to opt out
• No sites emailed us to express a desire to be excluded from this review
• We encourage all sites (and especially low/high performers) to discuss current
successes, opportunities and barriers
Temperature Management
TEMP-04-Peds
% of patients < 18 years old who have a
median core/near core body
temperature ≥ 36C (96.8F)
Measure Type: Standard (> 90%)
Time Period: Pt. In Room → Pt. Out Room
Exclusions: ASA 5&6, Cardiac, MRI, cases less
than or equal to 30 minutes
TEMP-03
% of patients who have a postoperative body
temperature ≤ 36C (96.8F)
Measure Type: Outcome/Inverse (< 10%)
Time Period: 30 min < Anesthesia End > 15 min
Inclusions: General and neuraxial cases
Exclusions: ASA 5&6, MAC cases, Cardiac, MRI
