Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study.
14 affiliations
- 1Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany. [email protected].
- 2Center for Translational & Clinical Research Aachen (CTC-A), Medical Faculty RWTH Aachen University, Aachen, Germany.
- 3Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Aachen, Germany.
- 4Alexianer Center for Mental Health, Aachen, Germany.
- 5Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Bonn, Germany.
- 6Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TUD Dresden University of Technology, Dresden, Germany.
- 7Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany.
- 8Department of Anesthesia, Intensive Care Medicine & Emergency Medicine, St. Marienhospital Vechta, Vechta, Germany.
- 9Department of Anesthesiology, Operative Intensive Care Medicine and Pain Medicine, Universitätsklinikum Münster, Münster, Germany.
- 10Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Christliches Krankenhaus Quakenbrück, Quakenbrück, Germany.
- 11Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Kliniken Landkreis Karlsruhe, Fürst-Stirum-Klinik Bruchsal, Rechbergklinik Bretten, Bruchsal, Germany.
- 12Department of Anesthesiology, Intensive Care and Emergency Medicine, Pain Therapy, Bergmannstrost Hospital, Halle, Germany.
- 13Faculty of Medicine, Martin-Luther University Halle-Wittenberg, Halle, Germany.
- 14Department of Anesthesiology, Intensive Care and Pain Therapy, Klinikum Traunstein, Traunstein, Germany.
Abstract
Purpose
Intraoperative 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
We 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
Over 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
This 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.
Related
- Interpretable machine learning for predicting intraoperative oxygenation impairment during one-lung ventilation in thoracic surgery: a retrospective cohort study
- Effect of intraoperative high positive end-expiratory pressure with recruitment manoeuvres versus low positive end-expiratory pressure on postoperative lung function in obese adults: a substudy of the protective ventilation in obese patients randomised controlled trial
- Photobiomodulation therapy combined with a static magnetic field in critically ill patients receiving invasive mechanical ventilation: protocol for a multicentre randomised triple-blind placebo-controlled trial.
- Global Protective Ventilator Settings Are Not Regional Protection: A Compartment-Resolved Framework for Personalizing Mechanical Ventilation in Acute Respiratory Distress Syndrome
- Driving pressure, simplified elastic mechanical power, and time to liberation from mechanical ventilation: a competing-risks and time-anchored observational study
BibTeX
@article{grußer2026intraoperative,
title = {{Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study.}},
author = {Linda Grüßer and András Keszei and Rolf Rossaint and Berit Zingraf and Julia Wallqvist and Sebastian Goldmann and Mark Coburn and Andreas Güldner and Thomas Hachenberg and Christian Hönemann and Thea Koch and Bert Mierke and Martin Schuster and Hermann Wrigge and Julia Schuler and Jan Larmann and Ana Kowark and NO-HARM Study Group and German Society of Anesthesiology and Intensive Care (GSAIC) Trials Group},
journal = {Canadian journal of anaesthesia = Journal canadien d'anesthesie},
year = {2026},
month = sep,
doi = {10.1007/s12630-026-03172-w},
url = {https://europepmc.org/article/MED/42842200},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Intraoperative ventilation settings in Germany: an observational multicentre cross-sectional study.
AU - Linda Grüßer
AU - András Keszei
AU - Rolf Rossaint
AU - Berit Zingraf
AU - Julia Wallqvist
AU - Sebastian Goldmann
AU - Mark Coburn
AU - Andreas Güldner
AU - Thomas Hachenberg
AU - Christian Hönemann
AU - Thea Koch
AU - Bert Mierke
AU - Martin Schuster
AU - Hermann Wrigge
AU - Julia Schuler
AU - Jan Larmann
AU - Ana Kowark
AU - NO-HARM Study Group
AU - German Society of Anesthesiology and Intensive Care (GSAIC) Trials Group
PY - 2026
DA - 2026/09/01
JO - Canadian journal of anaesthesia = Journal canadien d'anesthesie
DO - 10.1007/s12630-026-03172-w
UR - https://europepmc.org/article/MED/42842200
AB - Purpose Intraoperative 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 We 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 Over 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 This 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.
SN - 0832-610X
SN - 1496-8975
ER -