Takeshi Unoki

Changes in respiratory physiological dead space and compliance during non-abdominal, upper abdominal and lower abdominal surgery under general anaesthesia

Background and objective: To evaluate the temporal changes in respiratory physiological dead space and dynamic compliance of the respiratory system during non-abdominal, upper abdominal and lower abdominal surgery under general anaesthesia with intermittent positive pressure ventilation. Methods: Thirty-four adult patients were studied (non-abdominal surgery, n = 8; upper abdominal surgery, n = 13 and lower abdominal surgery in lithotomy position, n = 13). Physiological dead space was measured using the single breath carbon dioxide test. The physiological dead space to tidal volume ratio (VD/VT), dynamic compliance of respiratory system, expiratory tidal volume and respiratory rate were measured 10 min after tracheal intubation, and 30, 60 and 120 min later. Results: In lower abdominal surgery group, VD/VT was significantly increased at 120 min compared with 0 min (P = 0.005) and 30 min (P = 0.009). There were no significant differences in VD/VT between the three groups at any time point. Compliance decreased significantly in patients with upper abdominal (120 min) and lower abdominal surgery (60 and 120 min), but there were no significant changes during non-abdominal surgery. Conclusions: We found that the VD/VT increased in patients undergoing lower abdominal surgery in lithotomy and head down tilt, and compliance decreased in those undergoing upper abdominal and lower abdominal surgery over time.

923: POSITIVE EFFECTS OF THE HANDOFF SHEET SYSTEM ON PAIN MANAGEMENT

Learning Objectives: Pain management influences both physiological and psychological consequences. In our previous research, pain was assessed only in 52% of patients who have been receiving mechanical ventilation, though, pain assessment tools were implemented and were supposed to perform every 4 hours in our ICU. To encourage the efficient use of pain assessment tools, we implemented the hand-off sheet system. With the system, the staffs use a formatted report document in a hand-off process. The documents contain the required fields such as patient’s identification, agitation, delirium, pain and so on. This study was conducted to evaluate the influence of the hand-off sheet system on pain assessment and intervention for pain management. Methods: A retrospective observational study was performed from July 2015 to Jun 2016. We included all critically ill adults who were admitted to the intensive care unit (ICU) of the University of Tsukuba Hospital, Japan. For analysis, the number of records of objective pain assessment (behavioral pain scale [BPS] and numerical rating scale [NRS]) and administration of intravenous injection (IV) analgesics (Flurbiprofen axetil, Pentazocine, Acetaminophen, Buprenorphine Hydrochloride) were collected. We analyzed the corrected data with linear regression analysis and Spearman’s rank correlation coefficient. Results: After implementation of the hand-off sheet, the number of pain assessments increased 60.7 per day (95% confidence interval [CI]; 57.0 to 64.3, p < 0.0001). The number of IV analgesics administration increased 3.8 per day (95%CI: 3.5 to 4.1 p < 0.0001), after the implementation. In addition, there was a strong correlation between the number of pain assessment and the number of IV analgesics administration (ρ = 0.623, p = 0.03).Conclusions: The hand-off sheet system has the positive effects for pain managements. Implementation of the hand-off sheet system led to a beneficial increase in pain assessments. There was a strong correlation between the number of pain assessment and the number of IV analgesics administration.