scholarly journals Lung-protective Ventilation Combined With Pressure-controlled Ventilation Volume-guaranteed in Children Undergoing One-lung Ventilation: A Randomised Controlled Trial

2021 ◽  
Author(s):  
Change Zhu ◽  
Saiji Zhang ◽  
Shenghua Yu ◽  
Yuting Zhang ◽  
Rong Wei
Keyword(s):  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Dynamic Compliance ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Controlled Ventilation ◽  
Lung Aeration

Abstract The purpose of study was to evaluate the effect of lung-protective ventilation (LPV) combined with PCV-VG in children undergoing OLV. Patients were randomly assigned to the LPV combined with PCV-VG group (PCV-VG) or LPV group (volume-controlled ventilation). Both groups received tidal-volume ventilation of 8 ml kg-1 body weight during two-lung ventilation, 6 ml kg‑1 during OLV, with sustained 5 cmH2O positive end-expiratory pressure.The PCV-VG group exhibited lower PIP than the LPV group at T1 (16.8±2.3 vs. 18.7±2.7, P=0.001), T2 (20.2±2.7 vs. 22.4±3.3, P=0.001), and T3 (23.8±3.2 vs. 26.36±3.7, P=0.01). Dynamic compliance was higher in the PCV-VG group at T1, T2 , and T3 (P=0.01). After anaesthesia induction, lung aeration deteriorated, but with no immediate postoperative difference in both groups. Postoperative lung aeration improved and returned to normal from 2.5 h postextubation in both groups. No differences were observed in postoperative pulmonary complications, intra-operative desaturation, hospital stay. In paediatric patients, who underwent thoracoscopic surgery, PCV-VG combined with LPV was superior to LPV in its ability to provide ventilation with lower PIP and higher dynamic compliance. However, the long-term benefits of different ventilation strategies should be further investigated.

scholarly journals Pressure-Controlled Ventilation-Volume Guaranteed Mode Combined with an Open-Lung Approach Improves Lung Mechanics, Oxygenation Parameters, and the Inflammatory Response during One-Lung Ventilation: A Randomized Controlled Trial

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Jianli Li ◽  
Baogui Cai ◽  
Dongdong Yu ◽  
Meinv Liu ◽  
Xiaoqian Wu ◽  
...  
Keyword(s):  
Lung Ventilation ◽  
Protective Ventilation ◽  
Lung Mechanics ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Controlled Ventilation ◽  
Open Lung ◽  
Pressure Controlled Ventilation ◽  
Pressure Controlled ◽  
Open Lung Approach

We evaluated the effectiveness of pressure-controlled ventilation-volume guaranteed (PCV-VG) mode combined with open-lung approach (OLA) in patients during one-lung ventilation (OLV). First, 176 patients undergoing thoracoscopic surgery were allocated randomly to four groups: PCV+OLA (45 cases, PCV-VG mode plus OLA involving application of individualized positive end-expiratory pressure (PEEP) after a recruitment maneuver), PCV (44 cases, PCV-VG mode plus standard lung-protective ventilation with fixed PEEP of 5 cmH2O), VCV+OLA (45 cases, volume-controlled ventilation (VCV) plus OLA), and VCV (42 cases, VCV plus standard lung-protective ventilation). Mean airway pressure (Pmean), dynamic compliance (Cdyn), PaO2/FiO2 ratio, intrapulmonary shunt ratio (Qs/Qt), dead space fraction (VD/VT), and plasma concentration of neutrophil elastase were obtained to assess the effects of four lung-protective ventilation strategies. At 45 min after OLV, the median (interquartile range (IQR)) Pmean was higher in the PCV+OLA group (13.00 (12.00, 13.00) cmH2O) and the VCV+OLA group (12.00 (12.00, 14.00) cmH2O) than in the PCV group (11.00 (10.00, 12.00) cmH2O) and the VCV group (11.00 (10.00, 12.00) cmH2O) (P<0.05); the median (IQR) Cdyn was higher in the PCV+OLA group (27.00 (24.00, 32.00) mL/cmH2O) and the VCV+OLA group (27.00 (22.00, 30.00) mL/cmH2O) than in the PCV group (23.00 (21.00, 25.00) mL/cmH2O) and the VCV group (20.00 (18.75, 21.00) mL/cmH2O) (P<0.05); the median (IQR) Qs/Qt in the PCV+OLA group (0.17 (0.16, 0.19)) was significantly lower than that in the PCV group (0.19 (0.18, 0.20)) and the VCV group (0.19 (0.17, 0.20)) (P<0.05); VD/VT was lower in the PCV+OLA group (0.18±0.05) and the VCV+OLA group (0.19±0.07) than in the PCV group (0.21±0.07) and the VCV group (0.22±0.06) (P<0.05). The concentration of neutrophil elastase was lower in the PCV+OLA group than in the PCV, VCV+OLA, and VCV groups at total-lung ventilation 10 min after OLV (162.47±25.71, 198.58±41.99, 200.84±22.17, and 286.95±21.10 ng/mL, resp.) (P<0.05). In conclusion, PCV-VG mode combined with an OLA strategy leads to favorable effects upon lung mechanics, oxygenation parameters, and the inflammatory response during OLV.

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 &lt; 0.001), and positive end-expiratory pressure increased from 4 to 5 cm H2O (P &lt; 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

scholarly journals Driving Pressure during Thoracic Surgery

2019 ◽  
Vol 130 (3) ◽  
pp. 385-393 ◽  
Author(s):  
MiHye Park ◽  
Hyun Joo Ahn ◽  
Jie Ae Kim ◽  
Mikyung Yang ◽  
Burn Young Heo ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Tidal Volume ◽  
Odds Ratio ◽  
Lung Ventilation ◽  
Pulmonary Complications ◽  
Protective Ventilation ◽  
Driving Pressure ◽  
Pressure Group ◽  
Postoperative Pulmonary Complications ◽  
One Lung Ventilation

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Recently, several retrospective studies have suggested that pulmonary complication is related with driving pressure more than any other ventilatory parameter. Thus, the authors compared driving pressure–guided ventilation with conventional protective ventilation in thoracic surgery, where lung protection is of the utmost importance. The authors hypothesized that driving pressure–guided ventilation decreases postoperative pulmonary complications more than conventional protective ventilation. Methods In this double-blind, randomized, controlled study, 292 patients scheduled for elective thoracic surgery were included in the analysis. The protective ventilation group (n = 147) received conventional protective ventilation during one-lung ventilation: tidal volume 6 ml/kg of ideal body weight, positive end-expiratory pressure (PEEP) 5 cm H2O, and recruitment maneuver. The driving pressure group (n = 145) received the same tidal volume and recruitment, but with individualized PEEP which produces the lowest driving pressure (plateau pressure–PEEP) during one-lung ventilation. The primary outcome was postoperative pulmonary complications based on the Melbourne Group Scale (at least 4) until postoperative day 3. Results Melbourne Group Scale of at least 4 occurred in 8 of 145 patients (5.5%) in the driving pressure group, as compared with 18 of 147 (12.2%) in the protective ventilation group (P = 0.047, odds ratio 0.42; 95% CI, 0.18 to 0.99). The number of patients who developed pneumonia or acute respiratory distress syndrome was less in the driving pressure group than in the protective ventilation group (10/145 [6.9%] vs. 22/147 [15.0%], P = 0.028, odds ratio 0.42; 95% CI, 0.19 to 0.92). Conclusions Application of driving pressure–guided ventilation during one-lung ventilation was associated with a lower incidence of postoperative pulmonary complications compared with conventional protective ventilation in thoracic surgery.

scholarly journals Effects of Dexmedetomidine Infusion on Inflammatory Responses and Injury of Lung Tidal Volume Changes during One-Lung Ventilation in Thoracoscopic Surgery: A Randomized Controlled Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Chun-Yu Wu ◽  
Yi-Fan Lu ◽  
Man-Ling Wang ◽  
Jin-Shing Chen ◽  
Yen-Chun Hsu ◽  
...  
Keyword(s):  
Tidal Volume ◽  
Inflammatory Responses ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Saline Group ◽  
Medical Complication ◽  
Volume Changes ◽  
One Lung Ventilation ◽  
Monocyte Chemoattractant Protein 1

One-lung ventilation in thoracic surgery provokes profound systemic inflammatory responses and injury related to lung tidal volume changes. We hypothesized that the highly selective a2-adrenergic agonist dexmedetomidine attenuates these injurious responses. Sixty patients were randomly assigned to receive dexmedetomidine or saline during thoracoscopic surgery. There is a trend of less postoperative medical complication including that no patients in the dexmedetomidine group developed postoperative medical complications, whereas four patients in the saline group did (0% versus 13.3%,p=0.1124). Plasma inflammatory and injurious biomarkers between the baseline and after resumption of two-lung ventilation were particularly notable. The plasma high-mobility group box 1 level decreased significantly from 51.7 (58.1) to 33.9 (45.0) ng.ml−1(p<0.05) in the dexmedetomidine group, which was not observed in the saline group. Plasma monocyte chemoattractant protein 1 [151.8 (115.1) to 235.2 (186.9) pg.ml−1,p<0.05] and neutrophil elastase [350.8 (154.5) to 421.9 (106.1) ng.ml−1,p<0.05] increased significantly only in the saline group. In addition, plasma interleukin-6 was higher in the saline group than in the dexmedetomidine group at postoperative day 1 [118.8 (68.8) versus 78.5 (58.8) pg.ml−1,p=0.0271]. We conclude that dexmedetomidine attenuates one-lung ventilation-associated inflammatory and injurious responses by inhibiting alveolar neutrophil recruitment in thoracoscopic surgery.

Lung Isolation

2018 ◽  
Author(s):  
Bryan Hierlmeier ◽  
Vanetta Levesque ◽  
Henrique Vale
Keyword(s):  
Thoracoscopic Surgery ◽  
Hypoxic Pulmonary Vasoconstriction ◽  
Lung Ventilation ◽  
Double Lumen Tube ◽  
Lung Protective Ventilation ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Lung Isolation ◽  
Pulmonary Vasoconstriction ◽  
Protective Strategies

Lung isolation is being used more frequently in adult patients due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery. There are several indications for lung isolation and one-lung ventilation (OLV) during surgery. Isolation is usually achieved by double-lumen endotracheal tubes or use of some type of bronchial blocker system. The initiation of OLV frequently leads to hypoxemia, the management of which should be stepwise. Additionally, clinical outcomes are significantly improved with the use of lung protective strategies during OLV. This review covers the use of few of the most common lung isolation devices, management of OLV using lung protective ventilation strategies, and management of oxygenation and hypoxemia during OLV. This review contains 12 figures, 6 tables, and 36 references. Key Words: bronchial blockers, double-lumen tube, uninvent, hypoxemia, hypoxic pulmonary vasoconstriction, one lung ventilation, positive end expiratory pressure, tracheal anatomy, lung isolation

scholarly journals Preemptive one lung ventilation enhances lung collapse during thoracoscopic surgery: A randomized controlled trial

2019 ◽  
Vol 10 (6) ◽  
pp. 1448-1452
Author(s):  
Yunxiao Zhang ◽  
Wanpu Yan ◽  
Zhiyi Fan ◽  
Xiaozheng Kang ◽  
Hongyu Tan ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Thoracoscopic Surgery ◽  
Controlled Trial ◽  
Lung Ventilation ◽  
Lung Collapse ◽  
One Lung Ventilation ◽  
Randomized Controlled
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