Date of Award

Fall 10-1-2018

Degree Name

Doctor of Nursing Practice (DNP)


Leadership and Advanced Nursing Practice

Committee Chair

Dr. Marjorie Geisz-Everson

Committee Chair Department


Committee Member 2

Dr. Mary Jane Collins

Committee Member 2 Department



Obesity is considered a complex, and often difficult to manage the diseasethat develops due to many factors. Over one-third of the U.S. population is considered to be obese with Mississippi ranked as second highest in adult obesity (WHO, 2016). With the increasedprevalence of obese patients, it is inevitable that these patients will be presenting for surgical procedures. Obesity and its comorbidities can prove to be challenging for anesthesia providers. These patients often will have compromised respiratory function due to an accumulation of adipose tissue on the abdominal, thoracic, and diaphragmatic structures(Nagelhout, 2014). General anesthesia causes atelectasis and reductions in lung volume in the obese surgical patient(Futier et al., 2011). To combat the physiological challenges this patient population presents with, anesthesia providers must stay up to date with current evidence-based practice to prevent negative outcomes. Current evidence-based practice and literature supportthe utilization of noninvasive positive pressure ventilation (NIPPV), alveolar recruitment maneuvers (ARM), and positive end-expiratorypressure (PEEP) to improve obese surgical patient outcomes (Forgiarini, Rezende, & Forgiarini, 2013).

A quality improvement project was implemented which included the comparison between using NIPPV, ARM, and PEEP on induction of general anesthesia and traditional pre-oxygenation techniques. Over the course of a four-week time period, 14 participants meeting the inclusion criteria were included in this intervention. Seven participants, group one received the intervention and seven, group two did not. Group one showed an improvement in postoperative room air saturation over the preoperative room air saturation. Group twoshowed no improvement in postoperative room air saturation versus the recorded preoperative room air saturation. The usage of NIPPV, ARM, and PEEP resulted in improved post-operative room air saturated oxygen level (SpO2) on arrival to the post-anesthesia care unit as compared to the preoperative room air saturation.