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Positive end-expiratory pressure applied to the dependent lung during one-lung ventilation improves oxygenation and respiratory mechanics in patients with high FEV1

Published online by Cambridge University Press:  28 January 2005

F. Valenza ,
G. Ronzoni ,
L. Perrone ,
M. Valsecchi ,
S. Sibilla ,
M. Nosotti ,
L. Santambrogio ,
B. M. Cesana  and
L. Gattinoni
F. Valenza
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
G. Ronzoni
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
L. Perrone
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
M. Valsecchi
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
S. Sibilla
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
M. Nosotti
Affiliation:
Istituto di Chirurgia Toracica, Milan, Italy
L. Santambrogio
Affiliation:
Istituto di Chirurgia Toracica, Milan, Italy
B. M. Cesana
Affiliation:
Laboratorio epidemiologico – Direzione scientifica, Milan, Italy
L. Gattinoni
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
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Extract

Summary

Background and objective: The aim of this study was to test the efficacy of positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation, taking into consideration underlying lung function in order to select responders to PEEP.

Methods: Forty-six patients undergoing open-chest thoracic surgical procedures were studied in an operating room of a university hospital. Patients were randomized to receive zero end-expiratory pressure (ZEEP) or 10 cmH2O of PEEP to the dependent lung during one-lung ventilation in lateral decubitus. The patients were stratified according to preoperative forced expiratory volume in 1 s (FEV1) as an indicator of lung function (below or above 72%). Oxygenation was measured in the supine position, in the lateral decubitus with an open chest, and after 20 min of ZEEP or PEEP. The respiratory system pressure–volume curve of the dependent hemithorax was measured in supine and open-chest lateral decubitus positions with a super-syringe.

Results: Application of 10 cmH2O of PEEP resulted in a significant increase in PaO2 (P < 0.05). This did not occur in ZEEP group, considered as a time matched control. PEEP improved oxygenation only in patients with high FEV1 (from 11.6 ± 4.8 to 15.3 ± 7.1 kPa, P < 0.05). There was no significant change in the low FEV1 group. Dependent hemithorax compliance decreased in lateral decubitus, more in patients with high FEV1 (P < 0.05). PEEP improved compliance to a greater extent in patients with high FEV1 (from 33.6 ± 3.6 to 48.4 ± 3.9 mL cmH2O−1, P < 0.05).

Conclusions: During one-lung ventilation in lateral decubitus, PEEP applied to the dependent lung significantly improves oxygenation and respiratory mechanics in patients with rather normal lungs as assessed by high FEV1.

Keywords

RESPIRATION, ARTIFICIAL, intermittent positive pressure ventilation, positive pressure respiration, one-lung ventilationRESPIRATORY MECHANICSRESPIRATORY FUNCTION TESTS, lung compliance, pulmonary gas exchangeTHORACIC SURGERYPOSTURE, lateral position
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 12 , December 2004 , pp. 938 - 943
Copyright
© 2004 European Society of Anaesthesiology

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References

Tarhan S, Lundborg RO. Effects of increased expiratory pressure on blood gas tensions and pulmonary shunting during thoracotomy with use of the Carlens catheter. Can Anaesth Soc J 1970; 17: 4–11.Google Scholar
Brown DR, Kafer ER, Roberson VO, Wilcox BR, Murray GF. Improved oxygenation during thoracotomy with selective PEEP to the dependent lung. Anesth Analg 1977; 56: 26–31.Google Scholar
Katz JA, Laverne RG, Fairley HB, Thomas AN. Pulmonary oxygen exchange during endobronchial anesthesia: effect of tidal volume and PEEP. Anesthesiology 1982; 56: 164–171.Google Scholar
Hedenstierna G, Baehrendtz S, Klingstedt C, et al. Ventilation and perfusion of each lung during differential ventilation with selective PEEP. Anesthesiology 1984; 61: 369–376.Google Scholar
Baehrendtz S, Klingstedt C. Differential ventilation and selective PEEP during anaesthesia in the lateral decubitus posture. Acta Anaesthesiol Scand 1984; 28: 252–259.Google Scholar
Cohen E, Eisenkraft JB, Thys DM, Kirschner PA, Kaplan JA. Oxygenation and hemodynamic changes during one-lung ventilation: effects of CPAP 10, PEEP 10, and CPAP 10/PEEP 10. J Cardiothorac Anesth 1988; 2: 34–40.Google Scholar
Aalto-Setala M, Heinonen J, Salorinne Y. Cardiorespiratory function during thoracic anaesthesia: a comparison of two-lung ventilation and one-lung ventilation with and without PEEP 5. Acta Anaesthesiol Scand 1975; 19: 287–295.Google Scholar
Khanam T, Branthwaite MA. Arterial oxygenation during one-lung anaesthesia. 1. A study in man. Anaesthesia 1973; 28: 132–138.Google Scholar
Capan LM, Turndorf H, Patel C, Ramanathan S, Acinapura A, Chalon J. Optimization of arterial oxygenation during one-lung anesthesia. Anesth Analg 1980; 59: 847–851.Google Scholar
Gattinoni L, Pesenti A, Avalli L, Rossi F, Bombino M. Pressure–volume curve of total respiratory system in acute respiratory failure. Computed tomographic scan study. Am Rev Respir Dis 1987; 136: 730–736.Google Scholar
Strandberg A, Tokics L, Brismar B, Lundquist H, Hedenstierna G. Atelectasis during anaesthesia and in the postoperative period. Acta Anaesthesiol Scand 1986; 30: 154–158.Google Scholar
Westbrook PR, Stubbs SE, Sessler AD, Rehder K, Hyatt RE. Effects of anesthesia and muscle paralysis on respiratory mechanics in normal man. J Appl Physiol 1973; 34: 81–86.Google Scholar
Froese AB, Bryan AC. Effects of anesthesia and paralysis on diaphragmatic mechanics in man. Anesthesiology 1974; 41: 242–255.Google Scholar
Larsson A, Jonmarker C, Jogi P, Werner O. Ventilatory consequences of the lateral position and thoracotomy in children. Can J Anaesth 1987; 34: 141–145.Google Scholar
Klingstedt C, Hedenstierna G, Lundquist H, Strandberg A, Tokics L, Brismar B. The influence of body position and differential ventilation on lung dimensions and atelectasis formation in anaesthetized man. Acta Anaesthesiol Scand 1990; 34: 315–322.Google Scholar
Strandberg A, Tokics L, Brismar B, Lundquist H, Hedenstierna G. Constitutional factors promoting development of atelectasis during anaesthesia. Acta Anaesthesiol Scand 1987; 31: 21–24.Google Scholar
Gunnarson L, Tokics L, Gustavsson H, Hedenstierna G. Influence of age on atelectasis formation and gas exchange impairment during general anaesthesia. Br J Anaesth 1991; 66: 423–432.Google Scholar
Gunnarson L, Tokics L, Lundquist H, et al. Chronic obstructive pulmonary disease and anaesthesia: formation of atelectasis and gas exchange impairment. Eur Respir J 1991; 4: 1106–1116.Google Scholar
Slinger PD, Kruger M, McRae K, Winton T. Relation of the static compliance curve and positive end-expiratory pressure to oxygenation during one-lung ventilation. Anesthesiology 2001; 95: 1096–1102.Google Scholar
Moutafis M, Liu N, Dalibon N, et al. The effects of inhaled nitric oxide and its combination with intravenous almitrine on PaO2 during one-lung ventilation in patients undergoing thoracoscopic procedures. Anesth Analg 1997; 85: 1130–1135.Google Scholar
Chen TL, Ueng TH, Huang CH, Chen CL, Huang FY, Lin CJ. Improvement of arterial oxygenation by selective infusion of prostaglandin E1to ventilated lung during one-lung ventilation. Acta Anaesthesiol Scand 1996; 40: 7–13.Google Scholar
Rocca GD, Passariello M, Coccia C, et al. Inhaled nitric oxide administration during one-lung ventilation in patients undergoing thoracic surgery. J Cardiothor Vasc Anesth 2001; 15: 218–223.Google Scholar