How traditional and digital analytics interventions can enhance lung-protective ventilation strategies during general anaesthesia: A two-year quality improvement project analysis.

PURPOSE: This quality improvement project evaluated interventions implemented to enhance individual adherence to a lung-protective ventilation strategy and its triad: low tidal volume, PEEP ≥ 5, recruitment manoeuvres. METHODS: For two years, nine anaesthesia workstations were connected to an automated cloud-based analytics software tool, which automatically recorded ventilation parameters as soon as a new patient case was opened. Four quality improvement periods were determined over the first year: baseline, intervention, no intervention, intervention + digital. In the second year, the digital strategy was continued for nine months, followed by a final "overtime" period. Baseline and no intervention periods included no training. The intervention period included both conventional and educational programs. The digital period included pop-up messages, which automatically appeared on the screen of the anaesthesia data management system when patients were intubated. The primary endpoint was provider adherence to the recommended triad. RESULTS: From October 2018 to December 2020, 12,883 procedures were performed. Data were available for 8968 procedures: baseline (n = 2361), intervention (n = 2423), no intervention (n = 1064), intervention + digital (n = 1862), overtime (n = 1258). Age, Predicted Body Weight, ASA score, type of surgery and airway management were similar between periods. At baseline, 75.2% of procedures reported low tidal volume but only 6.9% involved the complete triad. At over time, Triad was 22% (p < 0.001). Over study period, each parameter of the Triad (RM, Vt and Peep) increased (p < 0.001 vs. baseline), driving pressure decreased although EtCO2 and plateau pressure had not changed. CONCLUSION: Training with the help of digital apps improved LPV adherence over time.

Incidental Extraspinal Findings in the Thoracic Spine during Magnetic Resonance Imaging of Intervertebral Discs.

OBJECTIVE: The purpose of this research was to determine the frequency of incidental extraspinal findings in the thoracic spine on magnetic resonance imaging (MRI). MATERIALS AND METHODS: A total of 120 thoracic spine MRI patients were prospectively examined in the period extending from August 2018 to April 2019. Both 1.5 and 0.35 Tesla MRI systems (Toshiba and Siemens Medical system) were applied to investigate patients with suspected intervertebral disc abnormalities at three MRI diagnostic centers in Khartoum, Sudan. RESULTS: Out of the 120 patients, incidental extraspinal findings were found in 16 patients (13.3%). Various incidental findings (IFs) were seen, including renal cysts, liver mass, thyroid goiter, and pleural effusion. Out of these IFs, 37.5% were considered clinically significant. CONCLUSIONS: Various IFs were identified during a routine thoracic spine MRI, and approximately one-third of them were clinically significant. Therefore, it is essential for the reporting radiologists to pay attention to extraspinal findings while reporting thoracic spine MRI to avoid missing clinically significant findings.