Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test.
10.4097/kjae.2014.67.2.96
- Author:
Jong Dal JUNG
1
;
Sang Hun KIM
;
Byung Sik YU
;
Hye Ji KIM
Author Information
1. Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ksh3223@Chosun.ac.kr
- Publication Type:Original Article ; Randomized Controlled Trial
- Keywords:
Alveolar recruitment;
One-lung ventilation;
Oxygenation;
PEEP;
Preemptive;
Tidal volume
- MeSH:
Anoxia;
Humans;
Lung Injury;
One-Lung Ventilation*;
Oxygen*;
Positive-Pressure Respiration;
Respiratory Function Tests*;
Thoracostomy;
Tidal Volume*;
Ventilation
- From:Korean Journal of Anesthesiology
2014;67(2):96-102
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND: Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP). METHODS: In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began. RESULTS: Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05). CONCLUSIONS: Preemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.
