Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position.
10.3349/ymj.2015.56.5.1421
- Author:
Yong Seon CHOI
1
;
Mi Kyung BAE
;
Shin Hyung KIM
;
Ji Eun PARK
;
Soo Young KIM
;
Young Jun OH
Author Information
1. Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. yjoh@yuhs.ac
- Publication Type:Original Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
- Keywords:
Alveolar recruitment;
one-lung ventilation;
positive end-expiratory pressure;
supine position
- MeSH:
Adult;
Aged;
Anoxia;
Female;
Humans;
Lung/physiopathology;
Lung Compliance/physiology;
Male;
Middle Aged;
One-Lung Ventilation/*methods;
Oxygen/*blood;
Positive-Pressure Respiration/*methods;
Pulmonary Alveoli/*physiology;
Pulmonary Gas Exchange;
Respiratory Mechanics/*physiology;
*Supine Position;
Thoracic Surgery, Video-Assisted;
Tidal Volume
- From:Yonsei Medical Journal
2015;56(5):1421-1427
- CountryRepublic of Korea
- Language:English
-
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 (TLVbaseline), 15 and 30 min after OLV (OLV15 and OLV30), and 10 min after re-establishing TLV (TLVend). RESULTS: Ultimately, 92 patients were analyzed. In the AR group, the arterial oxygen tension was higher at TLVend, and the physiologic dead space was lower at OLV15 and TLVend 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 TLVend. 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.
