scholarly journals Positive End-Expiratory Pressure (PEEP), Tidal Volume, or Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation?

2019 ◽  
Vol 9 (4) ◽  
pp. 452-458
Author(s):  
Taner Abdullah ◽  
Mert Şentürk
Keyword(s):  
Tidal Volume ◽  
Lung Ventilation ◽  
Alveolar Recruitment ◽  
Positive End Expiratory Pressure ◽  
One Lung Ventilation

Protective Ventilation Influences Systemic Inflammation after Esophagectomy

2006 ◽  
Vol 105 (5) ◽  
pp. 911-919 ◽  
Author(s):  
Pierre Michelet ◽  
Xavier-Benoît D’Journo ◽  
Antoine Roch ◽  
Christophe Doddoli ◽  
Valerie Marin ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Systemic Inflammation ◽  
Lung Ventilation ◽  
Protective Ventilation ◽  
Ventilation Strategy ◽  
Positive End Expiratory Pressure ◽  
One Lung Ventilation ◽  
Ventilatory Strategy ◽  
Protective Ventilation Strategy ◽  
Protective Strategy

Background Esophagectomy induces a systemic inflammatory response whose extent has been recognized as a predictive factor of postoperative respiratory morbidity. The aim of this study was to determine the effectiveness of a protective ventilatory strategy to reduce systemic inflammation in patients undergoing esophagectomy. Methods The authors prospectively investigated 52 patients undergoing planned esophagectomy for cancer. Patients were randomly assigned to a conventional ventilation strategy (n = 26; tidal volume of 9 ml/kg during two-lung and one-lung ventilation; no positive end-expiratory pressure) or a protective ventilation strategy (n = 26; tidal volume of 9 ml/kg during two-lung ventilation, reduced to 5 ml/kg during one-lung ventilation; positive end-expiratory pressure 5 cm H2O throughout the operative time). Results Plasmatic levels of interleukin (IL)-1beta, IL-6, IL-8, and tumor necrosis factor alpha were measured perioperatively and postoperatively. Pulmonary function and postoperative evolution were also evaluated. Patients who received protective strategy had lower blood levels of IL-1beta, IL-6, and IL-8 at the end of one-lung ventilation (0.24 [0.15-0.40] vs. 0.56 [0.38-0.89] pg/ml, P < 0.001; 91 [61-117] vs. 189 [127-294] pg/ml, P < 0.001; and 30 [22-45] vs. 49 [29-69] pg/ml, P < 0.05, respectively) and 18 h postoperatively (0.18 [0.13-0.30] vs. 0.43 [0.34-0.54] pg/ml, P < 0.001; 54 [36-89] vs. 116 [78-208] pg/ml, P < 0.001; 16 [11-24] vs. 35 [28-53] pg/ml, P < 0.001, respectively). Protective strategy resulted in higher oxygen partial pressure to inspired oxygen fraction ratio during one-lung ventilation and 1 h postoperatively and in a reduction of postoperative mechanical ventilation duration (115 +/- 38 vs. 171 +/- 57 min, P < 0.001). Conclusion A protective ventilatory strategy decreases the proinflammatory systemic response after esophagectomy, improves lung function, and results in earlier extubation.

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

2015 ◽  
Vol 56 (5) ◽  
pp. 1421 ◽  
Author(s):  
Yong Seon Choi ◽  
Mi Kyung Bae ◽  
Shin Hyung Kim ◽  
Ji-Eun Park ◽  
Soo Young Kim ◽  
...  
Keyword(s):  
Supine Position ◽  
Lung Ventilation ◽  
Alveolar Recruitment ◽  
Positive End Expiratory Pressure ◽  
One Lung Ventilation

scholarly journals A Lower Tidal Volume Regimen during One-lung Ventilation for Lung Resection Surgery Is Not Associated with Reduced Postoperative Pulmonary Complications

2021 ◽  
Vol 134 (4) ◽  
pp. 562-576
Author(s):  
Douglas A. Colquhoun ◽  
Aleda M. Leis ◽  
Amy M. Shanks ◽  
Michael R. Mathis ◽  
Bhiken I. Naik ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Tidal Volume ◽  
Lung Resection ◽  
Lung Ventilation ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
Postoperative Pulmonary Complications ◽  
Positive End Expiratory Pressure ◽  
One Lung Ventilation

Background Protective ventilation may improve outcomes after major surgery. However, in the context of one-lung ventilation, such a strategy is incompletely defined. The authors hypothesized that a putative one-lung protective ventilation regimen would be independently associated with decreased odds of pulmonary complications after thoracic surgery. Methods The authors merged Society of Thoracic Surgeons Database and Multicenter Perioperative Outcomes Group intraoperative data for lung resection procedures using one-lung ventilation across five institutions from 2012 to 2016. They defined one-lung protective ventilation as the combination of both median tidal volume 5 ml/kg or lower predicted body weight and positive end-expiratory pressure 5 cm H2O or greater. The primary outcome was a composite of 30-day major postoperative pulmonary complications. Results A total of 3,232 cases were available for analysis. Tidal volumes decreased modestly during the study period (6.7 to 6.0 ml/kg; P < 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P < 0.001). Despite increasing adoption of a “protective ventilation” strategy (5.7% in 2012 vs. 17.9% in 2016), the prevalence of pulmonary complications did not change significantly (11.4 to 15.7%; P = 0.147). In a propensity score matched cohort (381 matched pairs), protective ventilation (mean tidal volume 6.4 vs. 4.4 ml/kg) was not associated with a reduction in pulmonary complications (adjusted odds ratio, 0.86; 95% CI, 0.56 to 1.32). In an unmatched cohort, the authors were unable to define a specific alternative combination of positive end-expiratory pressure and tidal volume that was associated with decreased risk of pulmonary complications. Conclusions In this multicenter retrospective observational analysis of patients undergoing one-lung ventilation during thoracic surgery, the authors did not detect an independent association between a low tidal volume lung-protective ventilation regimen and a composite of postoperative pulmonary complications. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

Biologically Variable Ventilation Improves Oxygenation and Respiratory Mechanics during One-lung Ventilation

2006 ◽  
Vol 105 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Michael C. McMullen ◽  
Linda G. Girling ◽  
M Ruth Graham ◽  
W Alan C. Mutch
Keyword(s):  
Tidal Volume ◽  
Respiratory Mechanics ◽  
Lung Ventilation ◽  
Group Effect ◽  
Shunt Fraction ◽  
Static Compliance ◽  
One Lung Ventilation ◽  
Time Interaction ◽  
Variable Ventilation ◽  
Dead Space Ventilation

Background Hypoxemia is common during one-lung ventilation (OLV). Atelectasis contributes to the problem. Biologically variable ventilation (BVV), using microprocessors to reinstitute physiologic variability to respiratory rate and tidal volume, has been shown to be advantageous over conventional monotonous control mode ventilation (CMV) in improving oxygenation during the period of lung reinflation after OLV in an experimental model. Here, using a porcine model, the authors compared BVV with CMV during OLV to assess gas exchange and respiratory mechanics. Methods Eight pigs (25-30 kg) were studied in each of two groups. After induction of anesthesia-tidal volume 12 ml/kg with CMV and surgical intervention-tidal volume was reduced to 9 ml/kg. OLV was initiated with an endobronchial blocker, and the animals were randomly allocated to either continue CMV or switch to BVV for 90 min. After OLV, a recruitment maneuver was undertaken, and both lungs were ventilated for a further 60 min. At predetermined intervals, hemodynamics, respiratory gases (arterial, venous, and end-tidal samples) and mechanics (airway pressures, static and dynamic compliances) were measured. Derived indices (pulmonary vascular resistance, shunt fraction, and dead space ventilation) were calculated. Results By 15 min of OLV, arterial oxygen tension was greater in the BVV group (group x time interaction, P = 0.003), and shunt fraction was lower with BVV from 30 to 90 min (group effect, P = 0.0004). From 60 to 90 min, arterial carbon dioxide tension was lower with BVV (group x time interaction, P = 0.0001) and dead space ventilation was less from 60 to 90 min (group x time interaction, P = 0.0001). Static compliance was greater by 60 min of BVV and remained greater during return to ventilation of both lungs (group effect, P = 0.0001). Conclusions In this model of OLV, BVV resulted in superior gas exchange and respiratory mechanics when compared with CMV. Improved static compliance persisted with restoration of two-lung ventilation.

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