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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.


Related in: MedlinePlus

Changes in the PaCO2-ETCO2 difference (A) and estimated VD/VT (B). PaCO2-ETCO2, arterial to end-tidal carbon dioxide tension difference; estimated VD/VT, physiologic dead space. *p<0.05 vs. TLVbaseline in each group, †p<0.05 vs. control group.
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Figure 2: Changes in the PaCO2-ETCO2 difference (A) and estimated VD/VT (B). PaCO2-ETCO2, arterial to end-tidal carbon dioxide tension difference; estimated VD/VT, physiologic dead space. *p<0.05 vs. TLVbaseline in each group, †p<0.05 vs. control group.

Mentions: The arterial and central venous blood gas data are shown in Table 2. PaO2 was higher at TLVend (p=0.027) in the AR group than in the control group. The PaCO2-ETCO2 difference at OLV15 (p=0.043) and the estimated VD/VT at OLV15 and TLVend (p<0.05) decreased more in the AR group than in the control group (Fig. 2). When compared with TLVbaseline, PaO2 decreased while PaCO2 increased during OLV in all groups (p<0.01). At TLVend, PaO2 did not return to baseline values only in the control group. Compared with TLVbaseline, the estimated VD/VT increased at OLV30 and TLVend (p<0.05), and the PaCO2-ETCO2 difference increased during OLV and at TLVend (p<0.01) in the control group. Qs/Qt increased at OLV30 compared with TLVbaseline in all groups (p<0.05).


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)

Changes in the PaCO2-ETCO2 difference (A) and estimated VD/VT (B). PaCO2-ETCO2, arterial to end-tidal carbon dioxide tension difference; estimated VD/VT, physiologic dead space. *p<0.05 vs. TLVbaseline in each group, †p<0.05 vs. control group.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Changes in the PaCO2-ETCO2 difference (A) and estimated VD/VT (B). PaCO2-ETCO2, arterial to end-tidal carbon dioxide tension difference; estimated VD/VT, physiologic dead space. *p<0.05 vs. TLVbaseline in each group, †p<0.05 vs. control group.
Mentions: The arterial and central venous blood gas data are shown in Table 2. PaO2 was higher at TLVend (p=0.027) in the AR group than in the control group. The PaCO2-ETCO2 difference at OLV15 (p=0.043) and the estimated VD/VT at OLV15 and TLVend (p<0.05) decreased more in the AR group than in the control group (Fig. 2). When compared with TLVbaseline, PaO2 decreased while PaCO2 increased during OLV in all groups (p<0.01). At TLVend, PaO2 did not return to baseline values only in the control group. Compared with TLVbaseline, the estimated VD/VT increased at OLV30 and TLVend (p<0.05), and the PaCO2-ETCO2 difference increased during OLV and at TLVend (p<0.01) in the control group. Qs/Qt increased at OLV30 compared with TLVbaseline in all groups (p<0.05).

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.


Related in: MedlinePlus