Perioperative pulmonary-protection practices among Moroccan anaesthesiologists: a nationwide cross-sectional survey

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Postoperative pulmonary complications (PPCs) remain a major cause of perioperative morbidity and mortality. Although several strategies have been proposed to prevent PPCs, data regarding their implementation in routine practice remain limited. This study aimed to characterize reported PPC-prevention practices among Moroccan anaesthesiologists. We conducted a nationwide cross-sectional survey of anaesthesiologists in Morocco. The questionnaire assessed preoperative risk assessment and optimization, intraoperative anaesthetic and ventilatory management, neuromuscular blockade management, and postoperative respiratory care. Multivariable logistic regression was performed to identify factors independently associated with selected pulmonary-protection practices. A total of 212 anaesthesiologists completed the survey (response rate 35%). Use of a validated PPC risk prediction score was reported by only 8% of respondents. Smoking cessation counselling was commonly implemented, whereas respiratory prehabilitation and nutritional assessment were less frequently reported. Regional anaesthesia was routinely favoured whenever feasible by 90% of respondents. Several intraoperative pulmonary-protection measures, including protective ventilation, moderate PEEP, recruitment manoeuvres, pressure monitoring, and targeted oxygenation strategies, were routinely used by 62–73% of respondents. In contrast, verification of a train-of-four ratio >0.9 before extubation was reported by only 15% of respondents, whereas 68% routinely administered neuromuscular blockade antagonists without monitoring. University-affiliated practice was associated with greater reported use of several pulmonary-protection measures and lower use of antagonization without neuromuscular monitoring. Considerable variation was observed in reported perioperative pulmonary-protection practices, particularly in PPC risk assessment and quantitative neuromuscular monitoring. University affiliation was associated with differences in several reported practices. These findings identify potential targets for future implementation and quality-improvement studies.