14 www.mymsahq.org
ASPIRE FEATURED MEASURE: PUL 02
INTRODUCTION
ASPIRE (Anesthesiology Performance
Improvement and Reporting Exchange) is
a national anesthesia quality improvement
collaborative that includes 21 sites across
Michigan. Michigan-based sites are a core
component of ASPIRE and make up almost 1/2
of all participating sites.
A total of 24 measures make up the ASPIRE
database. is is the rst in a series of articles
that share quality improvement initiatives from
ASPIRE. With this article we will highlight
“PUL 02”, our low tidal volume measure.
Specically, tidal volume goals are ≤ 8cc/kg ideal
body weight, and data is pulled from electronic
health data to grade compliance throughout the
initiative.
EVIDENCE BASED RATIONALE
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 benet with low versus high
tidal volume techniques, and references can be
found below.
1-6
Exclusion criteria for this measure are patients
who have an ASA status of 5 or 6, are < 12yo,
weigh < 20kg, or have extremes of height,
in which case the measure is less applicable.
Additional measure details can be found at
https://mpog.org/les/quality/measures/PUL-
02_spec.pdf.
Nirav Shah, M.D.
Program Director, ASPIRE
RESULTS
e rst graph (Figure A) reveals compliance
with PUL 02. Each bar represents a dierent
participating clinical site/hospital and sites are
ranked from highest to lowest (and anonymized
for this article). e goal for this and most
ASPIRE measures is 90% compliance, and
currently only one center reaches this level. e
second graph (Figure B) demonstrates a steady
improvement in measure compliance state-wide
since data collection began.
DISCUSSION
ASPIRE sites participating in Michigan (and
around the country) have used a variety of
quality improvement techniques to improve their
performance. ese include changes to default
settings on anesthesia machines, feedback to
individual providers based on performance, and
lectures/ didactic sessions. Tools are available
from a variety of sources, including our website
(https://mpog.org/quality/toolkits/).
Given the wide variation in performance with
PUL 02 observed across ASPIRE sites, we must
continue our eorts to improve compliance with
this measure. We are encouraged that overall,
performance across ASPIRE sites is improving
in the last year, and hope that sites that are not
participating in ASPIRE will be able to use this
vignette, and access additional information on
our website (see links above) to address this
important topic.
Katie Buehler, RN, MS
Clinical Program Manager, ASPIRE
Spring 2019 15
Anonymized Performance for PUL 02 Across ASPIRE sites in Michigan
Figure A. Across all ASPIRE sites in Michigan, performance varies from approximately 50 – 90%. Goal
performance for this (and most other ASPIRE measures) is greater than 90%.
Figure B. Performance trend over the last year for ASPIRE sites in Michigan.
REFERENCES:
1. Brower RG, Matthay MA, Morris A, Schoenfeld D,
ompson BT, Wheeler A. Ventilation with lower tidal
volumes as compared with traditional tidal volumes
for acute lung injury and the acute respiratory distress
syndrome. e 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 aer 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. e 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. 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.
6. 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.
