Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T03:02:44.693Z Has data issue: false hasContentIssue false
  • English
  • Français

Prospective, randomized, controlled evaluation of the preventive effects of positive end-expiratory pressure on patient oxygenation during one-lung ventilation

Published online by Cambridge University Press:  11 July 2005

G. Mascotto ,
M. Bizzarri ,
M. Messina ,
E. Cerchierini ,
G. Torri ,
A. Carozzo  and
A. Casati
G. Mascotto
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
M. Bizzarri
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
M. Messina
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
E. Cerchierini
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
G. Torri
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
A. Carozzo
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
A. Casati
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
Get access

Extract

Summary

Background and objective: This prospective, randomized, controlled study evaluated the effects on oxygenation by applying a selective and patient-specific value of positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation.

Methods: Fifty patients undergoing thoracic surgery under combined epidural/general anaesthesia were randomly allocated to receive zero PEEP (Group ZEEP, n = 22), or the preventive application of PEEP, optimized on the best thoracopulmonary compliance (Group PEEP, n = 28). Patients' lungs were mechanically ventilated with the same setting during two- and one-lung ventilation (FiO2 = 0.5; VT = 9 mL kg−1, inspiratory : expiratory time = 1 : 1, inspiratory pause = 10%).

Results: Lung-chest wall compliance decreased in both groups during one-lung ventilation, but patients of Group PEEP had 10% higher values than patients with no end-expiratory pressure (ZEEP) applied – Group ZEEP (P < 0.05). During closed chest one-lung ventilation, the PaO2 : FiO2 ratio was lower in Group PEEP (232 ± 88) than in Group ZEEP (339 ± 97) (P < 0.05); but no further differences were reported throughout the study. No differences were reported between the two groups in the need for 100% oxygen ventilation (10 patients of Group ZEEP (45%) and 14 patients of Group PEEP (50%) (P = 0.78)) or re-inflation of the operated lung during surgery (two patients of Group ZEEP (9%) and three patients of Group PEEP (10%) (P = 0.78)). Postanaesthesia care unit discharge required 48 min (25th–75th percentiles: 32–58 min) in Group PEEP and 45 min (30–57 min) in Group ZEEP (P = 0.60).

Conclusions: The selective application of PEEP to the dependent, non-operated lung increases the lung–chest wall compliance during one-lung ventilation, but does not improve patient oxygenation.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia, epiduralANAESTHESIA, generalMONITORING, intraoperativeSPECIALTIES, SURGICAL, thoracic surgerySURGICAL PROCEDURES, OPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 9 , September 2003 , pp. 704 - 710
Copyright
© 2003 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Brodsky JB. Approaches to hypoxemia during single-lung ventilation. Curr Opin Anaesthesiol 2001; 14: 71–76.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. Acta Anaesthesiol Scand 1975; 19: 287–295.Google Scholar
Cohen E. One lung ventilation: prospective from an interested observer. Minerva Anestesiol 1999; 65: 275–283.Google Scholar
Benumof JL, Alfery DD. Anesthesia for thoracic surgery. In: Miller RD, ed. Anesthesia, 5th edn. New York, USA: Churchill Livingstone, 2000: 1665–1752.
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
Putensen C, Baum M, Hormann C. Selecting ventilator settings according to variables derived from the quasi-static pressure/volume relationship in patients with acute lung injury. Anesth Analg 1993; 77: 436–447.Google Scholar
Casati A, Valentini G, Ferrari S, Senatore R, Zangrillo A, Torri G. Cardiorespiratory changes during gynaecological laparoscopy by abdominal wall elevation: a comparison with carbon dioxide pneumoperitoneum. Br J Anaesth 1997; 78: 51–54.Google Scholar
Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg 1970; 49: 924–934.Google Scholar
Cohen E, Eisenkraft JB. Positive end-expiratory pressure during one-lung ventilation improves oxygenation in patients with low arterial oxygen tension. J Cardiothoracic Vasc Anesth 1996; 10: 578–582.Google Scholar
Browner WS, Black D, Newman B, et al. Estimating sample size and power. In: Designing Clinical Research – An Epidemiologic Approach. Baltimore, USA: Williams & Wilkins, 1988: 139–150.
Slinger P, Triolet W, Wilson J. Improving arterial oxygenation during one-lung ventilation. Anesthesiology 1988; 68: 291–295.Google Scholar
Eisenkraft JB, Cohen E, Neustein SM. Anesthesia for thoracic surgery. In: Barash PG, Cullen BF, Stoelting RK, eds. Clinical Anesthesia. Philadelphia, USA: Lippincott-Raven 1997: 779–784.
Katz JA, Laverne RG, Fairley HB, Thomas AN. Pulmonary oxygen exchange during endobronchial anesthesia: effects of tidal volume and PEEP. Anesthesiology 1982; 56: 164–171.Google Scholar
Carroll GC, Tuman KJ, Braverman B, et al. Minimal positive end-expiratory pressure (PEEP) may be ‘best PEEP’. Chest 1988; 93: 1020–1025.Google Scholar
Inomata S, Nishikawa T, Saito S, Kihara S. ‘Best’ PEEP during one-lung ventilation. Br J Anaesth 1997; 78: 754–756.Google Scholar
Larsson A, Malmkvist G, Werner O. Variations in lung volume and compliance during pulmonary surgery. Br J Anaesth 1987; 59: 585–591.Google Scholar
Klingstedt C, Baehrendtz S, Bindslev L, Hedenstierna G. Lung and chest wall mechanics during differential ventilation with selective PEEP. Acta Anaesthesiol Scand 1985; 29: 716–721.Google Scholar
Rimensberger PC, Pristine G, Mullen BM, Cox PN, Slutsky AS. Lung recruitment during small tidal volume ventilation allows minimal positive end-expiratory pressure without augmenting lung injury. Crit Care Med 1999; 27: 1940–1945.Google Scholar
Tokics L, Hedenstierna G, Strandberg A, Brismar B, Lundquist H. Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis and positive end-expiratory pressure. Anesthesiology 1987; 66: 157–167.Google Scholar
Eisenkraft JB. Hypoxic pulmonary vasoconstriction. Curr Opin Anaesthesiol 1999; 12: 43–48.Google Scholar
Ishibe Y, Shiokawa Y, Umeda T, Uno H, Nakamura M, Izumi T. The effect of thoracic epidural anesthesia on hypoxic pulmonary vasoconstriction in dogs: an analysis of the pressure–flow curve. Anesth Analg 1996; 82: 1049–1055.Google Scholar
Casati A, Salvo I, Torri G, Calderini E. Arterial to end tidal carbon dioxide gradient and physiological dead space monitoring during general anesthesia: effects of patients' position. Minerva Anestesiol 1997; 63: 177–182.Google Scholar
Vigil AR, Clevenger FW. The effects of positive end-expiratory pressure of intrapulmonary shunt and ventilatory deadspace in nonhypoxic trauma patients. J Trauma 1996; 40: 618–622.Google Scholar