{
  "abstract": "Purpose\n\nIntraoperative lung protective ventilation and, in inhalational anesthesia, minimal fresh gas flow (FGF) are recommended. It remains unclear how these recommendations are transferred to clinical routine. We aimed to assess corresponding anesthesia practices in Germany and raise awareness of optimal ventilation settings.Methods\n\nWe performed a pragmatic prospective observational national cross-sectional assessment of intraoperative ventilation settings in Germany, followed by an educational intervention and follow-up assessment. The intervention consisted of a pocket card designed in a Delphi-process. The patient-centred primary endpoint was tidal volume (VT)·kg⁻¹ ideal body weight (IBW), and the environment-centred primary endpoint was FGF in inhalational anesthesia. In a post hoc analysis, we grouped departments into quintiles of baseline VT and FGF, and explored changes after the intervention.Results\n\nOver 240 of 1,148 anesthesiology departments participated (21%). We collected data from 2,198 operating rooms in the first (preintervention) and 2,106 in the second (postintervention) assessment (96% response rate). The mean (standard deviation) VT·kg⁻¹ IBW was 7.4 (1.4) mL in the first assessment vs 7.3 (1.3) mL in the second assessment. The median [interquartile range (IQR)] FGFs were 0.60 [0.50-0.85] L·min⁻¹ vs 0.50 [0.45-0.75] L·min⁻¹, respectively. Exploratory multilevel regression analysis did not show an effect of the intervention. In the anesthesiology departments whose baseline ventilation settings were in the highest quintile, the intervention was associated with improvements in both VT and FGF.Conclusions\n\nThis large-scale clinical study of intraoperative ventilation settings in Germany found that most anesthesiologists already followed current recommendations. Therefore, for the entire cohort, no major improvements were observed. The educational intervention might improve ventilation settings in anesthesiology departments whose baseline practice deviates strongly from current recommendations.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany. lgruesser@ukaachen.de.",
    "Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany.",
    "Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.",
    "Alexianer Center for Mental Health, Aachen, Germany.",
    "Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany.",
    "Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.",
    "Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany.",
    "Department of Anesthesia, Intensive Care Medicine & Emergency Medicine, St. Marienhospital Vechta, Vechta, Germany.",
    "Department of Anesthesiology, Operative Intensive Care Medicine and Pain Medicine, Universitätsklinikum Münster, Münster, Germany.",
    "Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Christliches Krankenhaus Quakenbrück, Quakenbrück, Germany.",
    "Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal, Rechbergklinik Bretten, Bruchsal, Germany.",
    "Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital, Halle, Germany.",
    "Faculty of Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany.",
    "Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum Traunstein, Traunstein, Germany."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 19,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Linda Grüßer",
      "orcid": "0000-0002-1274-5611"
    },
    {
      "affs": [
        1
      ],
      "name": "András Keszei"
    },
    {
      "affs": [
        2
      ],
      "name": "Rolf Rossaint"
    },
    {
      "affs": [
        2
      ],
      "name": "Berit Zingraf"
    },
    {
      "affs": [
        2,
        3
      ],
      "name": "Julia Wallqvist"
    },
    {
      "affs": [
        2
      ],
      "name": "Sebastian Goldmann"
    },
    {
      "affs": [
        4
      ],
      "name": "Mark Coburn"
    },
    {
      "affs": [
        5
      ],
      "name": "Andreas Güldner"
    },
    {
      "affs": [
        6
      ],
      "name": "Thomas Hachenberg"
    },
    {
      "affs": [
        7,
        8
      ],
      "name": "Christian Hönemann"
    },
    {
      "affs": [
        5
      ],
      "name": "Thea Koch"
    },
    {
      "affs": [
        9
      ],
      "name": "Bert Mierke"
    },
    {
      "affs": [
        10
      ],
      "name": "Martin Schuster"
    },
    {
      "affs": [
        11,
        12
      ],
      "name": "Hermann Wrigge"
    },
    {
      "affs": [
        13
      ],
      "name": "Julia Schuler"
    },
    {
      "affs": [
        2
      ],
      "name": "Jan Larmann"
    },
    {
      "affs": [
        4
      ],
      "name": "Ana Kowark"
    },
    {
      "name": "NO-HARM Study Group"
    },
    {
      "name": "German Society of Anesthesiology and Intensive Care (GSAIC) Trials Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/692mktde49mag.bib",
  "cited_by": 0,
  "doi": "10.1007/s12630-026-03172-w",
  "fulltext_url": "https://europepmc.org/articles/PMC13687166",
  "id": "692mktde49mag",
  "issns": [
    "0832-610X",
    "1496-8975"
  ],
  "landing_url": "https://europepmc.org/article/MED/42842200",
  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2740|Respiratory Support and Mechanisms"
    ]
  ],
  "openalex": "W7220846084",
  "pdf_url": "https://europepmc.org/articles/PMC13687166?pdf=render",
  "pmcid": "PMC13687166",
  "pmid": "42842200",
  "published": "2026-09-01",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/692mktde49mag.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:10Z",
      "native_id": "MED:42842200",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42842200"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2740|Respiratory Support and Mechanisms",
      "subfield": "general"
    }
  ],
  "title": "Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study.",
  "title_text": "Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:10Z",
  "url": "https://research.draconitic.com/paper/692mktde49mag",
  "venue": "Canadian journal of anaesthesia = Journal canadien d'anesthesie",
  "versions": []
}