MPOG Pediatric
Subcommittee Meeting
March 7, 2023
Agenda
Announcements
Dr. Brad Taicher, Duke University
Measure Review: Intraoperative Normothermia (TEMP-04)
Dr. Vikas O’reilly-Shah, Seattle Children’s
QI Collaboratives in Pediatric Anesthesia
Dr. Jay Deshpande, Wake Up Safe
Pedi-Sustainability Update
Dr. Y. Eva Lu-Boettcher, University of Wisconsin
Upcoming Meetings
Friday, March 31, 2023
Update at SPA Quality & Safety
Austin, TX (hybrid)
June, 2023
MPOG Pediatric Subcommittee
Virtual
Friday, October 13, 2023
MPOG Annual Retreat
San Francisco, CA
QI Measure Page Updated
Additional Sections to note updates and measure contributors
New! Sustainability Dashboard
New! Informational Measure
Quality Committee Update
Meetings held January 24th and February 27th
Two measures reviewed
• Oral Morphine Equivalents, Intraop
– Pediatric measures include Tonsil/Adenoidectomy & Spine
– QC Vote: Modify or add separate measure for OME in PACU
• Transfer of Care: ICU
– Yes/no measure of whether ICU handoff was documented by anesthesia provider
– QC Vote: Continue as is, consider adding handoff elements in the future
New Measure Proposed and approved:
• Low dose Sugammadex use
Measure Review
TEMP 04
Dr. Vikas O’reilly-shah
Seattle Children’s
TEMP-04: Pediatric Normothermia, Intraop
Initial publish date: April 2020
Success: median core/near core body temperature > 36C (96.8F)
Time period: Patient in room → Patient out of room
Exclusions
• Patients ≥ 18yo
• ASA 5 & 6
• Cases < 30 minutes
• Cases without a temperature route documented
• Labor epidurals, Cardiac procedures, MRI
• MAC/Sedation cases
Provider Attribution: Provider present for the longest duration of the case (per staff role)
Discussion
Summary of recommended modifications
Easier
- Add hyperthermia criterion (any temp > 38)
- Add exclusion: gastroenterology
- Add exclusion: interventional radiology
- Add exclusion: cath lab/cardiology
- Add exclusion: preop temp <36 or >38
More controversial/harder
- Modify flag to encompass exposure length (not median), though the correct approach is unclear.
Disagree with using point values for hypothermia (e.g. single temp under 36). Possible approaches:
- Finite, defined exposure (> 15 minutes at <36)
- 25% of the procedure length (defined as surgery stop - surgery start)
- Some AUC based approach (depth * time of exposure)
TEMP 04
1 vote per site
Continue as is / modify / retire
Need > 50% to retire measure
Coordinating center will review all votes after meeting to
ensure no duplication
QI Collaboration
in Pediatric
Anesthesia
Dr. Jay Deshpande
Wake Up Safe
Pediatric
Sustainability
Update
Dr. Eva Lu-Boettcher
University of Wisconsin
Title
Table adapted from Eckelman et. al. June 2016
Table adapted from Sherman et al. April 2017
SUS-06-Peds: Low Fresh Gas Flow, Induction
Other Measure Details:
Table: Glenski et al 2022. “Low Flow Anesthesia in Pediatric Patients.”
Provider Attribution: All providers signed in during the induction period of anesthesia
Success Criteria: Mean FGF equal to, or less than the weight-based max FGF (L/min) during the induction
period of anesthesia, as displayed by table below
Weight (kg) Mean FGF
< 20 ≤ 3 L/min
20-30 ≤ 4 L/min
30-40 ≤ 5 L/min
> 40 ≤ 6 L/min
Simplified calculation for FGF Induction:
● Set FGF to exceed minute ventilation (VE) for open circuit conditions:
○ 150 mL x weight (kg), where VE~120 ml/kg estimate based upon VCO2 from Brody’s
equation:
Thank You!
