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Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position.

Choi YS, Bae MK, Kim SH, Park JE, Kim SY, Oh YJ - Yonsei Med. J. (2015)

Bottom Line: The tidal volume was reduced to 6 mL/kg during OLV in all groups.Ultimately, 92 patients were analyzed.No significant differences in hemodynamic variables were found among the three groups throughout the study period.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Hypoxemia during one-lung ventilation (OLV) remains a serious problem, particularly in the supine position. We investigated the effects of alveolar recruitment (AR) and positive end-expiratory pressure (PEEP) on oxygenation during OLV in the supine position.

Materials and methods: Ninety-nine patients were randomly allocated to one of the following three groups: a control group (ventilation with a tidal volume of 8 mL/kg), a PEEP group (the same ventilatory pattern with a PEEP of 8 cm H₂O), or an AR group (an AR maneuver immediately before OLV followed by a PEEP of 8 cm H₂O). The tidal volume was reduced to 6 mL/kg during OLV in all groups. Blood gas analyses, respiratory variables, and hemodynamic variables were recorded 15 min into TLV (TLV(baseline)), 15 and 30 min after OLV (OLV₁₅ and OLV₃₀), and 10 min after re-establishing TLV (TLV(end)).

Results: Ultimately, 92 patients were analyzed. In the AR group, the arterial oxygen tension was higher at TLV(end), and the physiologic dead space was lower at OLV₁₅ and TLV(end) than in the control group. The mean airway pressure and dynamic lung compliance were higher in the PEEP and AR groups than in the control group at OLV₁₅, OLV₃₀, and TLV(end). No significant differences in hemodynamic variables were found among the three groups throughout the study period.

Conclusion: Recruitment of both lungs with subsequent PEEP before OLV improved arterial oxygenation and ventilatory efficiency during video-assisted thoracic surgery requiring OLV in the supine position.

No MeSH data available.


The consort flow diagram. PEEP, positive end-expiratory pressure.
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Figure 1: The consort flow diagram. PEEP, positive end-expiratory pressure.

Mentions: One hundred six patients were assessed for eligibility; 99 of these patients consented to participate in the study and were randomly assigned to groups. Of the enrolled patients, seven patients were excluded from the study due to changes in the surgical plan during surgery; therefore, 92 patients completed the study (Fig. 1). Patients' characteristics and clinical data were similar among the groups (Table 1). None of the patients demonstrated dangerous hypoxemia (SpO2<90%) for a 30-min OLV period regardless of the side of surgical approach.


Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position.

Choi YS, Bae MK, Kim SH, Park JE, Kim SY, Oh YJ - Yonsei Med. J. (2015)

The consort flow diagram. PEEP, positive end-expiratory pressure.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541677&req=5

Figure 1: The consort flow diagram. PEEP, positive end-expiratory pressure.
Mentions: One hundred six patients were assessed for eligibility; 99 of these patients consented to participate in the study and were randomly assigned to groups. Of the enrolled patients, seven patients were excluded from the study due to changes in the surgical plan during surgery; therefore, 92 patients completed the study (Fig. 1). Patients' characteristics and clinical data were similar among the groups (Table 1). None of the patients demonstrated dangerous hypoxemia (SpO2<90%) for a 30-min OLV period regardless of the side of surgical approach.

Bottom Line: The tidal volume was reduced to 6 mL/kg during OLV in all groups.Ultimately, 92 patients were analyzed.No significant differences in hemodynamic variables were found among the three groups throughout the study period.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Hypoxemia during one-lung ventilation (OLV) remains a serious problem, particularly in the supine position. We investigated the effects of alveolar recruitment (AR) and positive end-expiratory pressure (PEEP) on oxygenation during OLV in the supine position.

Materials and methods: Ninety-nine patients were randomly allocated to one of the following three groups: a control group (ventilation with a tidal volume of 8 mL/kg), a PEEP group (the same ventilatory pattern with a PEEP of 8 cm H₂O), or an AR group (an AR maneuver immediately before OLV followed by a PEEP of 8 cm H₂O). The tidal volume was reduced to 6 mL/kg during OLV in all groups. Blood gas analyses, respiratory variables, and hemodynamic variables were recorded 15 min into TLV (TLV(baseline)), 15 and 30 min after OLV (OLV₁₅ and OLV₃₀), and 10 min after re-establishing TLV (TLV(end)).

Results: Ultimately, 92 patients were analyzed. In the AR group, the arterial oxygen tension was higher at TLV(end), and the physiologic dead space was lower at OLV₁₅ and TLV(end) than in the control group. The mean airway pressure and dynamic lung compliance were higher in the PEEP and AR groups than in the control group at OLV₁₅, OLV₃₀, and TLV(end). No significant differences in hemodynamic variables were found among the three groups throughout the study period.

Conclusion: Recruitment of both lungs with subsequent PEEP before OLV improved arterial oxygenation and ventilatory efficiency during video-assisted thoracic surgery requiring OLV in the supine position.

No MeSH data available.