Perioperative Lung Protection Strategies in One-lung and Two-lung Ventilation

2015 ◽  
Vol 43 (1) ◽  
pp. 93-103
Author(s):  
Peter Slinger
Keyword(s):  
Lung Ventilation ◽  
Lung Protection ◽  
Protection Strategies

Perioperative Lung Protection Strategies in Cardiothoracic Anesthesia

2012 ◽  
Vol 30 (4) ◽  
pp. 607-628 ◽  
Author(s):  
Peter Slinger ◽  
Bruce Kilpatrick
Keyword(s):  
Lung Protection ◽  
Protection Strategies

scholarly journals A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chuan-Yi Kuo ◽  
Ying-Tung Liu ◽  
Tzu-Shan Chen ◽  
Chen-Fuh Lam ◽  
Ming-Cheng Wu
Keyword(s):  
Clinical Practice ◽  
Practice Guideline ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Ventilator Support ◽  
Lung Protection ◽  
Expert Opinions ◽  
Survey Form ◽  
Thoracic Anesthesia ◽  
Protective Lung Ventilation

Abstract Background There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6–7 ml/kg PBW (67.6%) and a PEEP level of 4–6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 > 0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

Comparison of lung protection strategies using conventional and high-frequency oscillatory ventilation

2001 ◽  
Vol 91 (4) ◽  
pp. 1836-1844 ◽  
Author(s):  
Yumiko Imai ◽  
Satoshi Nakagawa ◽  
Yushi Ito ◽  
Toshio Kawano ◽  
Arthur S. Slutsky ◽  
...  
Keyword(s):  
High Frequency ◽  
Inflection Point ◽  
High Frequency Oscillatory Ventilation ◽  
High Peep ◽  
Small Airways ◽  
Lung Protection ◽  
Oscillatory Ventilation ◽  
Pulmonary Compliance ◽  
Protection Strategies ◽  
High Frequency Oscillatory

This study compared pathophysiological and biochemical indexes of acute lung injury in a saline-lavaged rabbit model with different ventilatory strategies: a control group consisting of moderate tidal volume (Vt) (10–12 ml/kg) and low positive end-expiratory pressure (PEEP) (4–5 cmH2O); and three protective groups: 1) low Vt (5–6 ml/kg) high PEEP, 2–3 cmH2O greater than the lower inflection point; 2) low Vt (5–6 ml/kg), high PEEP (8–10 cmH2O); and 3) high-frequency oscillatory ventilation (HFOV). The strategy using PEEP > inflection point resulted in hypotension and barotrauma. HFOV attenuated the decrease in pulmonary compliance, the lung inflammation assessed by polymorphonuclear leukocyte infiltration and tumor necrosis factor-α concentration in the alveolar space, and pathological changes of the small airways and alveoli. Conventional mechanical ventilation using lung protection strategies (low Vt high PEEP) only attenuated the decrease in oxygenation and pulmonary compliance. Therefore, HFOV may be a preferable option as a lung protection strategy.

scholarly journals A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

2020 ◽  
Author(s):  
Chuan-Yi Kuo ◽  
Ying-Tung Liu ◽  
Tzu-Shan Chen ◽  
Chen-Fuh Lam ◽  
Ming-Cheng Wu
Keyword(s):  
Clinical Practice ◽  
Practice Guideline ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Ventilator Support ◽  
Lung Protection ◽  
Expert Opinions ◽  
Survey Form ◽  
Thoracic Anesthesia ◽  
Protective Lung Ventilation

Abstract Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

scholarly journals A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

2019 ◽  
Author(s):  
Chuan-Yi Kuo ◽  
Ying-Tung Liu ◽  
Chen-Fuh Lam ◽  
Ming-Cheng Wu
Keyword(s):  
Clinical Practice ◽  
Practice Guideline ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Ventilator Support ◽  
Lung Protection ◽  
Expert Opinions ◽  
Survey Form ◽  
Thoracic Anesthesia ◽  
Protective Lung Ventilation

Abstract Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan.Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV.Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established.Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

Lung protection during one-lung ventilation

2018 ◽  
Vol 35 (10) ◽  
pp. 724-726 ◽  
Author(s):  
Lorenzo Ball ◽  
Chiara Robba ◽  
Marcelo Gama de Abreu ◽  
Paolo Pelosi
Keyword(s):  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Lung Protection

scholarly journals A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

2020 ◽  
Author(s):  
Chuan-Yi Kuo ◽  
Ying-Tung Liu ◽  
Tzu-Shan Chen ◽  
Chen-Fuh Lam ◽  
Ming-Cheng Wu
Keyword(s):  
Clinical Practice ◽  
Practice Guideline ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Ventilator Support ◽  
Lung Protection ◽  
Expert Opinions ◽  
Survey Form ◽  
Thoracic Anesthesia ◽  
Protective Lung Ventilation

Abstract Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan.Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV.Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established.Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

scholarly journals A nationwide survey of intraoperative management for one-lung ventilation in Taiwan: time to accountable for diversity in protective lung ventilation

2020 ◽  
Author(s):  
Chuan-Yi Kuo ◽  
Ying-Tung Liu ◽  
Tzu-Shan Chen ◽  
Chen-Fuh Lam ◽  
Ming-Cheng Wu
Keyword(s):  
Clinical Practice ◽  
Practice Guideline ◽  
Lung Ventilation ◽  
One Lung Ventilation ◽  
Ventilator Support ◽  
Lung Protection ◽  
Expert Opinions ◽  
Survey Form ◽  
Thoracic Anesthesia ◽  
Protective Lung Ventilation

Abstract Background: There is a major paradigm shift for intraoperative mechanical ventilator support by the introduction of lung protective ventilation strategies to reduce postoperative pulmonary complications and improve overall clinical outcomes in non-thoracic surgeries. However, there is currently a lack of standardized practice guideline for lung protection during thoracic surgeries that require one-lung ventilation (OLV). This study aimed to collect the expert opinions of the thoracic anesthesiologists in perioperative care for OLV surgery in Taiwan. Methods: This prospective cross-sectional study was undertaken in 16 tertiary hospitals in Taiwan from January to February 2019. A structured survey form was distributed across the participating hospitals and the thoracic anesthesiologists were invited to complete the form voluntarily. The survey form consisted of three parts, including the basic information of the institutional anesthesia care standards, ventilatory settings for a proposed patient receiving OLV surgery and expert opinions on OLV. Results: A total of 71 thoracic anesthesiologists responded to the survey. Double-lumen tubes are the most commonly used (93.8%) airway devices for OLV. The most commonly recommended ventilator setting during OLV is a tidal volume of 6-7 ml/kg PBW (67.6%) and a PEEP level of 4-6 cmH2O (73.5%). Dual controlled ventilator modes are used by 44.1% of the anesthesiologists. During OLV, high oxygen fraction (FiO2 >0.8) is more commonly supplemented to achieve an oxygen saturation higher than 94%. The consensus of anesthesiologists on the indices for lung protection in thoracic surgery is considerably low. Large majority of the anesthesiologists (91.5%) highly recommend that an international clinical practice guideline on the protective lung ventilation strategy for thoracic anesthesia should be established. Conclusions: This study found that the thoracic anesthesiologists in Taiwan share certain common practices in ventilator support during OLV. However, they are concerned about the lack of fundamental clinical evidences to support the beneficial outcomes of the current lung protective strategies applicable to OLV. Large-scale trials are needed to form an evidence-based clinical practice guideline for thoracic anesthesia.

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