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Purayil AP, Nair SG, Abraham J, Vazhakatt JD, Rajmohan N, Shaji A. Continuous Positive Airway Pressure versus Differential Lung Ventilation during One Lung Ventilation for Thoracic Surgery. Ann Card Anaesth 2024; 27:235-240. [PMID: 38963358 PMCID: PMC11315257 DOI: 10.4103/aca.aca_46_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/15/2024] [Accepted: 03/28/2024] [Indexed: 07/05/2024] Open
Abstract
INTRODUCTION One lung ventilation (OLV) is a technique used during lung resection surgery to facilitate optimal surgical conditions. However, this may result in severe hypoxemia due to the right-to-left shunt created in the collapsed lung. Several techniques are used to overcome hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV) or split lung ventilation (SLV). In this study, we compared the efficacy of CPAP to DLV during video-assisted thoracoscopic (VATS) lung resection. MATERIALS AND METHODS In this single-center randomized controlled, cross-over study, each patient acted as his control as well as the study. Patients crossed over from SLV to CPAP (or vice versa) with an interval period during which only OLV was used (control period). The primary objective of the study was to observe the changes in oxygenation, ventilation, and the surgeons' perception of the surgical field using CPAP or SLV to the non-ventilated lung during the period of OLV in patients undergoing thoracic surgery. RESULTS The study revealed that oxygenation was significantly better when using SLV to the non-ventilated lung during the period of OLV (P = 0.03). However, the surgeon found a significantly better surgical field when applying CPAP to the surgical field. CONCLUSIONS The study showed that using SLV to the non-ventilated lung during the period of OLV was superior in terms of oxygenation, although it interfered more with the surgical field.
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Affiliation(s)
- Aswathy Puthan Purayil
- Department of Anaesthesiology and Critical Care, Aster Medcity, Kuttisahib Road Cheranalloor, South Chitoor, Kochi, Kerala, India
| | - Suresh Gangadharan Nair
- Department of Anaesthesiology and Critical Care, Aster Medcity, Kuttisahib Road Cheranalloor, South Chitoor, Kochi, Kerala, India
| | - Jobin Abraham
- Department of Anaesthesiology and Critical Care, Aster Medcity, Kuttisahib Road Cheranalloor, South Chitoor, Kochi, Kerala, India
| | - Joel Devasia Vazhakatt
- Department of Anaesthesiology and Critical Care, Aster Medcity, Kuttisahib Road Cheranalloor, South Chitoor, Kochi, Kerala, India
| | - Nisha Rajmohan
- Department of Anaesthesiology and Critical Care, Aster Medcity, Kuttisahib Road Cheranalloor, South Chitoor, Kochi, Kerala, India
| | - Anupama Shaji
- Department of Anaesthesiology and Critical Care, Aster Medcity, Kuttisahib Road Cheranalloor, South Chitoor, Kochi, Kerala, India
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Pfitzner J. One-lung Ventilation Techniques to Facilitate Thoracoscopic Surgery: Time for Some Different Studies? J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00284-2. [PMID: 38890082 DOI: 10.1053/j.jvca.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 06/20/2024]
Affiliation(s)
- John Pfitzner
- The Queen Elizabeth Hospital, Discipline of Surgery, University of Adelaide, South Australia, Australia
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Yang Y, Jia D, Cheng L, Jia K, Wang J. Continuous positive airway pressure combined with small-tidal-volume ventilation on arterial oxygenation and pulmonary shunt during one-lung ventilation in patients undergoing video-assisted thoracoscopic lobectomy: A randomized, controlled study. Ann Thorac Med 2024; 19:155-164. [PMID: 38766377 PMCID: PMC11100470 DOI: 10.4103/atm.atm_240_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND One-lung ventilation (OLV) is frequently applied during video-assisted thoracoscopic surgery (VATS) airway management to collapse and isolate the nondependent lung (NL). OLV can give rise to hypoxemia as a result of the pulmonary shunting produced. Our study aimed to assess the influence of continuous positive airway pressure (CPAP) combined with small-tidal-volume ventilation on improving arterial oxygenation and decreasing pulmonary shunt rate (QS/QT) without compromising surgical field exposure during OLV. METHODS Forty-eight patients undergoing scheduled VATS lobectomy were enrolled in this research and allocated into three groups at random: C group (conventional ventilation, no NL ventilation intervention was performed), LP group (NL was ventilated with lower CPAP [2 cmH2O] and a 40-60 mL tidal volume [TV]), and HP group (NL was ventilated with higher CPAP [5 cmH2O] and a 60-80 mL TV). Record the blood gas analysis data and calculate the QS/QT at the following time: at the beginning of the OLV (T0), 30 min after OLV (T1), and 60 min after OLV (T2). Surgeons blinded to ventilation techniques were invited to evaluate the surgical fields. RESULTS The demography data of the three groups were consistent with the surgical data. At T1, PaO2 in the HP group was substantially higher compared to the C group (P < 0.05), while there was no significant difference in the LP group (P > 0.05). At T1-T2, PaCO2 in the LP and HP groups was significantly less than that in the C group (P < 0.05). At T1, the QS/QT values of groups C, LP, and HP were 29.54 ± 6.89%, 22.66 ± 2.08%, and 19.64 ± 5.76%, respectively, and the QS/QT values in the LP and HP groups markedly reduced (P < 0.01). The surgical field's evaluation by the surgeon among the three groups was not notable (P > 0.05). CONCLUSION CPAP combined with small-tidal-volume ventilation effectively improved arterial oxygenation and reduced QS/QT and PaCO2 without compromising surgical field exposure during OLV. Among them, 5 cmH2O CPAP + 60-80 ml TV ventilation had a better effect on improving oxygenation.
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Affiliation(s)
- Yudie Yang
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Dong Jia
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Lu Cheng
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ke Jia
- Department of Thoracic Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ji Wang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Zhou Y, Jiang Y, Ding Y, Gu L, Tan J. Placement of bronchial occluder outside the tracheal tube in a patient combined with airway compression undergoing mediastinal tumors resection: a case report. BMC Anesthesiol 2024; 24:100. [PMID: 38475719 DOI: 10.1186/s12871-024-02480-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Mediastinal tumors pose a challenging respiratory and circulatory management during anesthesia procedures, there is a risk of circulatory collapse or complete airway obstruction, which in severe cases can lead to cardiac arrest. We reported a case of anesthetic management using a bronchial blocker placed outside the tracheal tube. In this case report, the patient's trachea was so severely compressed that the airway was extremely narrow, only 4 mm at its narrowest point. By reporting the anesthetic management of this patient, we intend to provide an unusual approach for airway management. CASE PRESENTATION A 52-year-old male patient was admitted to the hospital due to cough and expectoration for one year. Additionally, the patient experienced chest tightness and asthma after physical activity. The enhanced computed tomography revealed there existed an irregular soft tissue mass in the right upper mediastinum, which significantly compressed the trachea and esophagus. The results of the mediastinal puncture pathology showed the presence of mesenchymal tumors. According to the results above, the patient was diagnosed with a mediastinal tumor and scheduled to undergo tumor resection under general anesthesia. We used a bronchial occluder outside the tracheal tube for general anesthesia. After surgery, the patient received thorough treatment and was subsequently discharged from the hospital. CONCLUSION In patients with severe airway compression from a mediastinal tumor airway compression, positioning a bronchial occluder externally to the tracheal tube is an effective method of airway management. However, we still need more clinical practice to help the process become more standardized.
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Affiliation(s)
- Yihu Zhou
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 21009, People's Republic of China
| | - Yueyi Jiang
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 21009, People's Republic of China
| | - Yuyan Ding
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 21009, People's Republic of China
| | - Lianbing Gu
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 21009, People's Republic of China.
| | - Jing Tan
- Department of Anesthesiology, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 21009, People's Republic of China.
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Abstract
'Apnoeic oxygenation' describes the diffusion of oxygen across the alveolar-capillary interface in the absence of tidal respiration. Apnoeic oxygenation requires a patent airway, the diffusion of oxygen to the alveoli, and cardiopulmonary circulation. Apnoeic oxygenation has varied applications in adult medicine including facilitating tubeless anaesthesia or improving oxygenation when a difficult airway is known or anticipated. In the paediatric population, apnoeic oxygenation prolongs the time to oxygen desaturation, facilitating intubation. This application has gained attention in neonatal intensive care where intubation remains a challenging procedure. Difficulties are related to the infant's size and decreased respiratory reserve. In addition, policy changes have led to limited opportunities for operators to gain proficiency. Until recently, evidence of benefit of apnoeic oxygenation in the neonatal population came from a small number of infants recruited to paediatric studies. Evidence specific to neonates is emerging and suggests apnoeic oxygenation may increase intubation success and limit physiological instability during the procedure. The best way to deliver oxygen to facilitate apnoeic oxygenation remains an important question.
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Affiliation(s)
- Elizabeth K Baker
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia.
| | - Peter G Davis
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia.
| | - Kate A Hodgson
- Newborn Research Centre, Royal Women's Hospital, Victoria, Australia, Level 7, 20 Flemington Rd, Parkville, Victoria, 3052, Australia; Department of Obstetrics, Gynaecology and Newborn Health, University of Melbourne, Parkivlle, Victoria, Australia.
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Li YL, Hang LH. Recommendations and considerations for speeding the collapse of the non-ventilated lung during single-lung ventilation in thoracoscopic surgery: a literature review. Minerva Anestesiol 2023; 89:792-803. [PMID: 37307029 DOI: 10.23736/s0375-9393.23.17272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Video-assisted thoracoscopic thoracic surgery has the advantages of less physical damage, less postoperative pain, and a rapid recovery. Therefore, it is widely used in the clinic. The quality of nonventilated lung collapse is the key point of thoracoscopic surgery. Poor lung collapse on the operative side damages surgical exposure and prolongs the process of surgery. Therefore, it is important to achieve good lung collapse as soon as possible after opening the pleura. Over the past two decades, there have been reports of advances in research on the physiological mechanism of lung collapse and several kinds of techniques for speeding up lung collapse. This review will inform the advances of each technique, make recommendations for reasonable implementation and discuss their controversies and considerations.
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Affiliation(s)
- Yu-Lin Li
- Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Kunshan, China
| | - Li-Hua Hang
- Gusu School, Nanjing Medical University, The First People's Hospital of Kunshan, Kunshan, China -
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Joe YE, Lee CY, Kim N, Lee K, Kang SJ, Oh YJ. Effect of permissive hypercarbia on lung oxygenation during one-lung ventilation and postoperative pulmonary complications in patients undergoing thoracic surgery: A prospective randomised controlled trial. Eur J Anaesthesiol 2023; 40:691-698. [PMID: 37455644 DOI: 10.1097/eja.0000000000001873] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND The effect of hypercarbia on lung oxygenation during thoracic surgery remains unclear. OBJECTIVE To investigate the effect of hypercarbia on lung oxygenation during one-lung ventilation in patients undergoing thoracic surgery and evaluate the incidence of postoperative pulmonary complications. DESIGN Prospective randomised controlled trial. SETTING A tertiary university hospital in the Republic of Korea from November 2019 to December 2020. PATIENTS Two hundred and ninety-seven patients with American Society of Anaesthesiologists physical status II to III, scheduled to undergo elective lung resection surgery. INTERVENTION Patients were randomly assigned to Group 40, 50, or 60. An autoflow ventilation mode with a lung protective ventilation strategy was applied to all patients. Respiratory rate was adjusted to maintain a partial pressure of arterial carbon dioxide of 40 ± 5 mmHg in Group 40, 50 ± 5 mmHg in Group 50 and 60 ± 5 mmHg in Group 60 during one-lung ventilation and at the end of surgery. MAIN OUTCOME MEASURES The primary outcome was the arterial oxygen partial pressure/fractional inspired oxygen ratio after 60 min of one-lung ventilation. RESULTS Data from 262 patients were analysed. The partial pressure/fractional inspired oxygen ratio was significantly higher in Group 50 and Group 60 than in Group 40 (269.4 vs. 262.9 vs. 214.4; P < 0.001) but was not significantly different between Group 50 and Group 60. The incidence of postoperative pulmonary complications was comparable among the three groups. CONCLUSION Permissive hypercarbia improved lung oxygenation during one-lung ventilation without increasing the risk of postoperative pulmonary complications or the length of hospital stay. TRIAL REGISTRATION NCT04175379.
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Affiliation(s)
- Young-Eun Joe
- From the Department of Anaesthesiology and Pain Medicine, and Anaesthesia and Pain Research Institute (Y-EJ, NK, KL, SJK, YJO) and Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea (CYL)
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Liu C, Zhao Y, Li Y, Guan H, Feng J, Cheng S, Wang X, Wang Y, Sun X. Comparative study of a modified double-lumen tube ventilation control connector and traditional connector in clinical use: a randomised-controlled trial. BMC Anesthesiol 2022; 22:281. [PMID: 36068501 PMCID: PMC9446794 DOI: 10.1186/s12871-022-01816-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 08/08/2022] [Indexed: 11/26/2022] Open
Abstract
Background A Y-shaped rotatable connector (YRC) for double-lumen tubes (DLT) is invented and compared with the traditional connector (Y-shaped connector, YC). Methods Sixty patients with ASA grade I-III, aged ≥ 18 years, who needed to insert a DLT for thoracic surgery were recruited and assigned into the YRC group (n = 30) and the YC group (n = 30) randomly. The primary endpoints included the inhaled air concentration (Fi) and the exhaled air concentration (Et) of sevoflurane before and after the switch between two-lung ventilation and one-lung ventilation at different times, positioning time, and switching time. The secondary endpoints were the internal gas volume of the two connectors, airway pressure, and the sputum suction time. Results The Et and Fi of the YRC group and the YC group were significantly different (all p < 0.05) at 5s, 10s, and 30s after the patient switched from two-lung ventilation to one-lung ventilation. The positioning time of the YRC group was less than YC group (89.75 ± 14.28 s vs 107.80 ± 14.96 s, p < 0.05), as well as the switching time (3.60 ± 1.20 s vs 9.05 ± 2.53 s, p < 0.05) and the internal gas volume (17.20 ml vs 24.12 ml). There was no difference in airway pressure and the sputum suction time in two groups. Conclusion Compared with YC, YRC was beneficial for maintaining depth of anesthesia, improves efficiency for the switch between one-lung and two-lung ventilation, and shortens the tube positioning time. 1. YRC was beneficial to maintain the stability of anesthesia depth.
2. YRC improves the conversion efficiency for one-lung and two-lung ventilation.
3. YRC shortens the positioning time.
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Affiliation(s)
- Chang Liu
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Yuanyu Zhao
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - You Li
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Huiwen Guan
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Junjie Feng
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Shengquan Cheng
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Xin Wang
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Yue Wang
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China
| | - Xufang Sun
- Department of Anesthesiology, The Second Hospital of Jilin University, No.218, Ziqiang street, Nanguan District, Changchun City, 130000, Jilin Province, China.
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McGlothlin D, Granton J, Klepetko W, Beghetti M, Rosenzweig EB, Corris P, Horn E, Kanwar M, McRae K, Roman A, Tedford R, Badagliacca R, Bartolome S, Benza R, Caccamo M, Cogswell R, Dewachter C, Donahoe L, Fadel E, Farber HW, Feinstein J, Franco V, Frantz R, Gatzoulis M, Hwa (Anne) Goh C, Guazzi M, Hansmann G, Hastings S, Heerdt P, Hemnes A, Herpain A, Hsu CH, Kerr K, Kolaitis N, Kukreja J, Madani M, McCluskey S, McCulloch M, Moser B, Navaratnam M, Radegran G, Reimer C, Savale L, Shlobin O, Svetlichnaya J, Swetz K, Tashjian J, Thenappan T, Vizza CD, West S, Zuckerman W, Zuckermann A, De Marco T. ISHLT CONSENSUS STATEMENT: Peri-operative Management of Patients with Pulmonary Hypertension and Right Heart Failure Undergoing Surgery. J Heart Lung Transplant 2022; 41:1135-1194. [DOI: 10.1016/j.healun.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 10/17/2022] Open
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:208-241. [PMID: 35585017 DOI: 10.1016/j.redare.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyzes, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, Spain
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - G Sanchez-Pedrosa
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, Spain
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de la Ribera, Alzira, Valencia, Spain
| | - P Piñeiro
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Cruz
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F de la Gala
- Servicio Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, Spain
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario A Coruña, La Coruña, Spain
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, Spain
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, Spain
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, Spain
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, Spain
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, Spain
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Licker M, Hagerman A, Jeleff A, Schorer R, Ellenberger C. The hypoxic pulmonary vasoconstriction: From physiology to clinical application in thoracic surgery. Saudi J Anaesth 2021; 15:250-263. [PMID: 34764832 PMCID: PMC8579502 DOI: 10.4103/sja.sja_1216_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/04/2022] Open
Abstract
More than 70 years after its original report, the hypoxic pulmonary vasoconstriction (HPV) response continues to spark scientific interest on its mechanisms and clinical implications, particularly for anesthesiologists involved in thoracic surgery. Selective airway intubation and one-lung ventilation (OLV) facilitates the surgical intervention on a collapsed lung while the HPV redirects blood flow from the "upper" non-ventilated hypoxic lung to the "dependent" ventilated lung. Therefore, by limiting intrapulmonary shunting and optimizing ventilation-to-perfusion (V/Q) ratio, the fall in arterial oxygen pressure (PaO2) is attenuated during OLV. The HPV involves a biphasic response mobilizing calcium within pulmonary vascular smooth muscles, which is activated within seconds after exposure to low alveolar oxygen pressure and that gradually disappears upon re-oxygenation. Many factors including acid-base balance, the degree of lung expansion, circulatory volemia as well as lung diseases and patient age affect HPV. Anesthetic agents, analgesics and cardiovascular medications may also interfer with HPV during the perioperative period. Since HPV represents the homeostatic mechanism for regional ventilation-to-perfusion matching and in turn, for optimal pulmonary oxygen uptake, a clear understanding of HPV is clinically relevant for all anesthesiologists.
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Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, CH-1205 GENEVA, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
| | - Andres Hagerman
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, CH-1205 GENEVA, Switzerland
| | - Alexandre Jeleff
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, CH-1205 GENEVA, Switzerland
| | - Raoul Schorer
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, CH-1205 GENEVA, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, University Hospital of Geneva, CH-1205 GENEVA, Switzerland.,Faculty of Medicine, University of Geneva, Switzerland
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12
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Salter R, Parmar J, Alyward L, McKie MA, Falter F. Association of Passive Lung Insufflation Oxygen Fraction in Adult Patients on Cardiopulmonary Bypass with Postoperative Pulmonary Outcomes: A Retrospective Cohort Study. J Cardiothorac Vasc Anesth 2021; 36:461-468. [PMID: 34756804 DOI: 10.1053/j.jvca.2021.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To determine whether FIO2 of passive lung insufflation during cardiopulmonary bypass correlates with postoperative pulmonary function. DESIGN A retrospective, observational study SETTING: A single-center, university-affiliated, specialist cardiothoracic center in the United Kingdom. PARTICIPANTS Adult patients presenting for nonemergency, nontransplant cardiac surgery requiring cardiopulmonary bypass without the need for deep hypothermic circulatory arrest between January 1, 2018, and December 31, 2018. INTERVENTIONS Passive insufflation of the lungs during cardiopulmonary bypass with fresh gas flow of varying FIO2. Patients were sorted retrospectively into low FIO2 (0.21-0.44), intermediate FIO2 (0.45-0.69), and high FIO2 (0.7-1.0) groups. The primary outcome was the difference between the PaO2:FIO2 on the first postinduction blood gas and on the first blood gas recorded postoperatively in the intensive care unit (ICU) (delta PaO2:FIO2). Secondary outcomes were ICU and hospital lengths of stay, requirement for respiratory support, and 30-day mortality. MEASUREMENTS AND MAIN RESULTS Nine hundred patients were included in the authors' analysis (low FIO2 n = 307, intermediate FIO2 n = 459, high FIO2 n = 134). There was no significant difference in delta PaO2:FIO2 among the groups (low FIO2 = 52.5 [-38.8 to 152.4], intermediate FIO2 = 71.8 [-39.4 to 165.1], high FIO2 = 60.2 [-19.2 to 184.0], p = 0.25). There were no significant differences among groups for any secondary outcomes. CONCLUSION Fresh gas flow with a low FIO2 delivered to the lungs without positive airway pressure during cardiopulmonary bypass was not associated with improved postoperative pulmonary function when compared to higher FIO2 levels.
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Affiliation(s)
- Ryan Salter
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Jasvir Parmar
- Transplant Services, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Liam Alyward
- Cambridge Perfusion Services, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Mikel A McKie
- MRC Biostatistics Unit, School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Florian Falter
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom.
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13
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Campos JH, Peacher D. Application of Continuous Positive Airway Pressure During Video-Assisted Thoracoscopic Surgery. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:446-456. [PMID: 34393664 PMCID: PMC8353220 DOI: 10.1007/s40140-021-00479-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/14/2022]
Abstract
Purpose of Review Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are used for anatomic resection of early stage cancer. These surgical techniques require the use of one-lung ventilation (OLV). During OLV, an obligatory intrapulmonary shunt may produce hypoxemia. One method to correct hypoxemia is with the use of continuous positive airway pressure (CPAP). This review focuses on 1) the lung physiology of OLV; 2) application of CPAP in VATS or RATS during supine and lateral position; and 3) the application of CPAP in COVID-19 patients during OLV. Recent Findings Studies have shown the beneficial effects of CPAP to improve oxygenation during OLV while the patient is in the lateral decubitus position. In contrast, studies have shown no benefit on improving oxygenation with CPAP in patients undergoing OLV in supine position. Summary The application of CPAP to the non-dependent lung is one of the options to treat hypoxemia during VATS or RATS.
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Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Carver College of Medicine, University of Iowa Healthcare, 200 Hawkins Drive, Iowa City, IA 5221 USA
| | - Dionne Peacher
- Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA USA
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14
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Garutti I, Cabañero A, Vicente R, Sánchez D, Granell M, Fraile CA, Real Navacerrada M, Novoa N, Sanchez-Pedrosa G, Congregado M, Gómez A, Miñana E, Piñeiro P, Cruz P, de la Gala F, Quero F, Huerta LJ, Rodríguez M, Jiménez E, Puente-Maestu L, Aragon S, Osorio-Salazar E, Sitges M, Lopez Maldonado MD, Rios FT, Morales JE, Callejas R, Gonzalez-Bardancas S, Botella S, Cortés M, Yepes MJ, Iranzo R, Sayas J. Recommendations of the Society of Thoracic Surgery and the Section of Cardiothoracic and Vascular Surgery of the Spanish Society of Anesthesia, Resuscitation and Pain Therapy, for patients undergoing lung surgery included in an intensified recovery program. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 69:S0034-9356(21)00102-X. [PMID: 34294445 DOI: 10.1016/j.redar.2021.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
In recent years, multidisciplinary programs have been implemented that include different actions during the pre, intra and postoperative period, aimed at reducing perioperative stress and therefore improving the results of patients undergoing surgical interventions. Initially, these programs were developed for colorectal surgery and from there they have been extended to other surgeries. Thoracic surgery, considered highly complex, like other surgeries with a high postoperative morbidity and mortality rate, may be one of the specialties that most benefit from the implementation of these programs. This review presents the recommendations made by different specialties involved in the perioperative care of patients who require resection of a lung tumor. Meta-analyses, systematic reviews, randomized and non-randomized controlled studies, and retrospective studies conducted in patients undergoing this type of intervention have been taken into account in preparing the recommendations presented in this guide. The GRADE scale has been used to classify the recommendations, assessing on the one hand the level of evidence published on each specific aspect and, on the other hand, the strength of the recommendation with which the authors propose its application. The recommendations considered most important for this type of surgery are those that refer to pre-habilitation, minimization of surgical aggression, excellence in the management of perioperative pain and postoperative care aimed at providing rapid postoperative rehabilitation.
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Affiliation(s)
- I Garutti
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España; Departamento de Farmacología y Toxicología, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - A Cabañero
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - R Vicente
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - D Sánchez
- Servicio de Cirugía Torácica, Hospital Clínic, Barcelona, España
| | - M Granell
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - C A Fraile
- Servicio de Cirugía Torácica, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Real Navacerrada
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - N Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca (CAUS), Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, España
| | - G Sanchez-Pedrosa
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Congregado
- Servicio de Cirugía Torácica, Hospital Virgen de la Macarena, Sevilla, España
| | - A Gómez
- Unitat de Rehabilitació Cardiorespiratòria, Hospital Universitari Vall d'Hebron, Barcelona, España
| | - E Miñana
- Servicio de Anestesia y Reanimación, Hospital de La Ribera, Alzira, Valencia, España
| | - P Piñeiro
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - P Cruz
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F de la Gala
- Servicio de Anestesia y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - F Quero
- Servicio de Cirugía Torácica, Hospital Universitario Virgen de las Nieves, Granada, España
| | - L J Huerta
- Servicio de Cirugía Torácica, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M Rodríguez
- Servicio de Cirugía Torácica, Clínica Universidad de Navarra, Madrid, España
| | - E Jiménez
- Fisioterapia Respiratoria, Hospital Universitario de A Coruña, La Coruña, España
| | - L Puente-Maestu
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - S Aragon
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - E Osorio-Salazar
- Servicio de Anestesia y Reanimación, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - M Sitges
- Bloc Quirúrgic i Esterilització, Hospital del Mar, Parc de Salut Mar, Barcelona, España
| | | | - F T Rios
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - J E Morales
- Servicio de Anestesia y Reanimación, Hospital General, Valencia, España
| | - R Callejas
- Servicio de Anestesia, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario, Valencia, España
| | - S Gonzalez-Bardancas
- Servicio de Anestesia y Reanimación, Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - S Botella
- Servicio de Anestesia y Reanimación, Hospital La Fe, Valencia, España
| | - M Cortés
- Servicio de Anestesia y Reanimación, Hospital Universitario 12 de Octubre, Madrid, España
| | - M J Yepes
- Servicio de Anestesia y Reanimación, Clínica Universidad de Navarra, Navarra, Pamplona, España
| | - R Iranzo
- Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - J Sayas
- Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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15
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In reply: The need to better understand the physiology of lung collapse during one-lung ventilation. Can J Anaesth 2021; 68:1454-1455. [PMID: 34160756 DOI: 10.1007/s12630-021-02041-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/06/2021] [Accepted: 05/28/2021] [Indexed: 10/21/2022] Open
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Yoon S, Kim BR, Min SH, Lee J, Bahk JH, Seo JH. Repeated intermittent hypoxic stimuli to operative lung reduce hypoxemia during subsequent one-lung ventilation for thoracoscopic surgery: A randomized controlled trial. PLoS One 2021; 16:e0249880. [PMID: 33857201 PMCID: PMC8049270 DOI: 10.1371/journal.pone.0249880] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 03/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background An intervention to potentiate hypoxic pulmonary vasoconstriction may reduce intrapulmonary shunt and hypoxemia during one-lung ventilation. Previous animal studies reported that repeated intermittent hypoxic stimuli potentiated hypoxic pulmonary vasoconstriction, but no clinical study has examined the effects of this intervention on hypoxemia during one-lung ventilation. We thus performed a single-center, parallel-group, double-blind, randomized controlled trial to investigate whether repeated intermittent hypoxic stimuli to the operative lung reduce hypoxemia during the subsequent one-lung ventilation for thoracoscopic surgery. Methods Patients undergoing one-lung ventilation were randomized into two groups (n = 68 each). Before one-lung ventilation, in the intermittent hypoxia group, the nondependent lung was not ventilated for 2 min and then ventilated for 2 min while the dependent lung was continuously ventilated. This was repeated five times. In the continuous normoxia group, both lungs were ventilated for 20 min. We measured SpO2, PaO2, FiO2, PaCO2, SaO2, and central venous oxygen saturation during one-lung ventilation. The primary outcome was the number of patients with hypoxemia defined as a SpO2 <95% during one-lung ventilation, which was analyzed with a chi-squared test. Results Hypoxemia was less frequent in the intermittent hypoxia group than in the continuous normoxia group during OLV [6/68 (8.8%) vs 17/68 (25.0%), risk ratio (95% CI) 0.35 (0.15–0.84), p = 0.012]. The PaO2 (p = 0.008 for 30 min and 0.007 for 60 min) and PaO2/FiO2 (p = 0.008 for both) were higher 30 and 60 min after starting one-lung ventilation, and the alveolar-arterial pressure gradient (p = 0.010) and shunt index (p = 0.008) were lower 30 min after starting one-lung ventilation in the intermittent hypoxia group than in the continuous normoxia group. Postoperative adverse events did not differ significantly between groups. Conclusions Repeated intermittent hypoxic stimuli to the operative lung seemed to potentiate hypoxic pulmonary vasoconstriction, and thus reduced hypoxemia during the subsequent one-lung ventilation.
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Affiliation(s)
- Susie Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo Rim Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se-Hee Min
- Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jaehun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Hyon Bahk
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Hwa Seo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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17
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Sawasdiwipachai P, Weerayutwattana R, Thongcharoen P, Suksompong S. Comparison of High-Flow Humidified Oxygen With Conventional Continuous Positive Airway Pressure in Nonventilated Lungs During Thoracic Surgery: A Randomized Cross-Over Study. J Cardiothorac Vasc Anesth 2021; 35:2945-2951. [PMID: 33985884 DOI: 10.1053/j.jvca.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study assessed the efficacy of high-flow humidified oxygen (HFHO) as an alternative to continuous positive airway pressure (CPAP) for improving oxygenation while preserving nonventilated lung collapse during one-lung ventilation. DESIGN A prospective randomized cross-over trial. SETTING A tertiary medical center. PARTICIPANTS The study comprised 28 patients undergoing elective thoracotomy with one-lung ventilation using a double-lumen endobronchial tube placement. INTERVENTIONS The patients received prophylactic CPAP or HFHO to the nonventilated lung for 20 minutes and were then crossedover to the other oxygenation modality for 20 minutes, with a 20-minute recovery interval between the two modalities. MEASUREMENTS AND MAIN RESULTS Changes in respiratory parameters and lung deflation quality were recorded. Both CPAP and HFHO increased the partial pressure of arterial oxygen in either sequence in both groups, ranging from 31.8-to-66.0 mmHg. However, the increments from these two interventions were not statistically significant (95% confidence interval -12.84 to 21.87; p = 0.597). There were no differences in other parameters. Half the patients receiving CPAP experienced worsening of the surgical condition, whereas the HFHO patients experienced no change or reported a better lung deflation (p < 0.001). CONCLUSION HFHO could be an alternative method to CPAP for improving arterial oxygenation while preserving lung deflation during one-lung ventilation. However, additional studies are warranted in regard to its cost-effectiveness and establishment as a routine treatment.
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Affiliation(s)
- Prasert Sawasdiwipachai
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Punnarerk Thongcharoen
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirilak Suksompong
- Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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18
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Thornton M, Reid D, Shelley B, Steven M. Management of the airway and lung isolation for thoracic surgery during the COVID‐19 pandemic. Anaesthesia 2020; 75:1509-1516. [DOI: 10.1111/anae.15112] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2020] [Indexed: 12/17/2022]
Affiliation(s)
- M. Thornton
- Department of Cardiothoracic Anaesthesia Golden Jubilee National Hospital Glasgow UK
| | - D. Reid
- Department of Cardiothoracic Anaesthesia Golden Jubilee National Hospital Glasgow UK
| | - B. Shelley
- Department of Cardiothoracic Anaesthesia and Intensive Care Medicine Golden Jubilee National Hospital Glasgow UK
- Academic Unit of Anaesthesia, Pain and Critical Care University of Glasgow UK
| | - M. Steven
- Department of Cardiothoracic Anaesthesia Golden Jubilee National Hospital Glasgow UK
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19
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Carramiñana A, Ferrando C, Unzueta MC, Navarro R, Suárez-Sipmann F, Tusman G, Garutti I, Soro M, Pozo N, Librero J, Gallego L, Ramasco F, Rabanal JM, Rodriguez A, Sastre J, Martinez J, Coves S, García P, Aguirre-Puig P, Yepes J, Lluch A, López-Herrera D, Leal S, Vives M, Bellas S, Socorro T, Trespalacios R, Salazar CJ, Mugarra A, Cinnella G, Spadaro S, Futier E, Ferrer L, Cabrera M, Ribeiro H, Celestino C, Kucur E, Cervantes O, Morocho D, Delphy D, Ramos C, Villar J, Belda J. Rationale and Study Design for an Individualized Perioperative Open Lung Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV). J Cardiothorac Vasc Anesth 2019; 33:2492-2502. [DOI: 10.1053/j.jvca.2019.01.056] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/21/2019] [Accepted: 01/24/2019] [Indexed: 11/11/2022]
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20
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Wang C, Ke H, Xu X, Chen J, Sun D, Ji F. Protective effect of nicorandil on collapse‑induced lung injury in rabbits by inhibiting apoptosis. Int J Mol Med 2019; 44:725-736. [PMID: 31173181 DOI: 10.3892/ijmm.2019.4236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 05/24/2019] [Indexed: 11/06/2022] Open
Abstract
The one‑lung ventilation (OLV) technique is vital in thoracic surgery. However, it can result in severe lung injury, which is difficult to manage. The main solution at present is the use of ventilation strategies, including continuous positive oxygen pressure, low tidal volume and high frequency ventilation, and the administering of drugs, including phenylephrine, dexmedetomidine and morphine. However, the protective effect of these methods on the lungs is not sufficient to improve the prognosis of patients. Therefore, how to develop a novel protective drug remains an open question. Nicorandil, a mitochondrial (mito)KATP‑specific opener, serves an important role in cardioprotection, although its effect on lung injury remains unclear. The present study examined the protective role of nicorandil against collapse‑induced lung injury in rabbits undergoing OLV. Changes in arterial oxygen saturation (SaO2), arterial partial pressure for oxygen (PaO2), wet/dry weight ratio, and the microstructure of tissues and cells were observed. Enzyme‑linked immunosorbent assays were used to determine the concentrations of malondialdehyde (MDA) and tumor necrosis factor (TNF)‑α, and the activity of superoxide dismutase (SOD) in rabbits treated with nicorandil. Terminal deoxynucleotidyl transferase transfer‑mediated dUTP nick end‑labeling was used to detect apoptosis and western blotting was used to analyze the relative proteins involved in apoptosis. Western blotting and reverse transcription‑quantitative polymerase chain reaction analysis were used to examine the expression of hypoxia inducible factor 1α (HIF‑1α), phosphatidylinositol‑3‑kinase (PI3K), protein kinase B (Akt) and nuclear factor (NF)‑κB in the lungs of rabbits treated with nicorandil. The SaO2 and PaO2 in the high‑dose group were significantly higher than those in the control group in the process of OLV. The wet/dry weight ratio, and the concentrations of MDA and TNF‑α in the collapsed lung of the high‑dose group were significantly lower than those in the control group. The activity of SOD in the high‑dose group was significantly higher than that in the control group. The lung had improved microstructure and less apoptosis, which was determined by the Bax/Bcl2 ratio in the high‑dose group. The expression levels of PI3K, phosphorylated Akt and HIF‑1α were upregulated, whereas the expression of NF‑κB was downregulated. In conclusion, nicorandil had a protective effect via inhibiting apoptosis in non‑ventilated lung collapsed and re‑expansion during OLV in the rabbit. It acted on mitoKATP through the PI3K/Akt signaling pathway.
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Affiliation(s)
- Chunguang Wang
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Honggang Ke
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Xingguo Xu
- Department of Anesthesiology, The Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Junjie Chen
- Department of Anesthesiology, The Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Dongyun Sun
- Department of Ophthalmic Operating Room, The Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, P.R. China
| | - Fuhai Ji
- Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Lyons C, Callaghan M. Uses and mechanisms of apnoeic oxygenation: a narrative review. Anaesthesia 2019; 74:497-507. [DOI: 10.1111/anae.14565] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2018] [Indexed: 12/31/2022]
Affiliation(s)
- C. Lyons
- Department of Anaesthesia; Mater Misericordiae University Hospital; Dublin Ireland
| | - M. Callaghan
- Department of Anaesthesia; Galway University Hospitals; Galway Ireland
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Can apneic oxygen insufflation become a novel lung protective ventilation strategy? A randomized, controlled, blinded, single center clinical trial. BMC Anesthesiol 2018; 18:186. [PMID: 30537951 PMCID: PMC6290548 DOI: 10.1186/s12871-018-0652-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/26/2018] [Indexed: 11/29/2022] Open
Abstract
Objective The aim of this study was to determine whether a AOI strategy on non-ventilated lung could reduce the regional and systemic proinflammatory cytokine and oxidative stress response associated with esophagectomy, and to evaluate whether AOI can be used as a novel lung protective ventilation strategy. Its impact on oxygenation after OLV, surfactant protein A, B, C (SP-A, B, C), postoperative hospital stay and postoperative pulmonary complications (PPCs) was also evaluated. Methods Fifty-four adults (ASA II-III) undergoing esophagectomy with OLV were enrolled in the study. Patients were randomly assigned into 2 groups: control group (group C) and treated group (group T). Group C was treated with traditional OLV mode,while group T was given AOI of 5 L/min oxygen on the non-ventilated lung immediately at the beginning of OLV. Arterial blood gas was analyzed before and after OLV. A bronchoalveolar lavage(BAL) was performed after OLV on the non-ventilated lung. Proinflammatory cytokine, oxidative stress markers(TNF-α, NF-κB,sICAM-1,IL-6,IL-10,SOD,MDA) and SP-A, B, C were analyzed in serum and BALF as the primary endpoint.The clinical outcome determined by PPCs was assessed as the secondary endpoint. Results Patients with AOI had better oxygenation in the recovery period, oxygenation index(OI) (394[367–426] and 478[440–497]mmHg, respectively) of group T at T2 and T3 were significantly higher than those (332[206–434] and 437[331–512]mmHg, respectively) of group C. OLV resulted in an increase in the measured inflammatory markers in both groups, however, the increase of inflammatory markers upon OLV in the group C was significantly higher than those of group T. OLV resulted in an increase in the measured SP-A, B, C in serum of both groups. However, the levels of SP-A, B, C of group T were lower than those of group C in serum after OLV, and the results in BALF were the opposite. The BALF levels of SOD(23.88[14.70–33.93]U/ml) of group T were higher than those(15.99[10.33–24.16] U/ml) of group C, while the levels of MDA in both serum and BALF of group T(8.60[4.14–9.85] and 1.88[1.33–3.08]nmol/ml, respectively) were all lower than those of group C (11.10[6.57–13.75] and 1.280[1.01–1.83]nmol/ml) after OLV. There was no statistical difference between the two groups in terms of postoperative hospital stay and the incidence of PPCs. Conclusion AOI on non-ventilated lung during OLV can improve the oxygenation function after OLV, relieve the inflammatory and oxidative stress response in the systemic and non-ventilated lung after OLV associated with esophagectomy. Trial registration ChiCTR-IOR-17011037. Registered on 31 March 2017.
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23
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Weksler B. Oxygen insufflation during 1-lung ventilation. J Thorac Cardiovasc Surg 2018; 155:1313. [PMID: 29452476 DOI: 10.1016/j.jtcvs.2017.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Benny Weksler
- Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tenn
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24
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Campos JH, Feider A. Hypoxia During One-Lung Ventilation-A Review and Update. J Cardiothorac Vasc Anesth 2017; 32:2330-2338. [PMID: 29361458 DOI: 10.1053/j.jvca.2017.12.026] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Javier H Campos
- Department of Anesthesia, University of Iowa Health Care, Iowa City, IA.
| | - Andrew Feider
- Division of Cardiothoracic Anesthesia, Department of Anesthesia, University of Iowa Health Care, Iowa City, IA
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25
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Weksler B. The merit of oxygen insufflation during one-lung ventilation. J Thorac Cardiovasc Surg 2017; 154:2123. [PMID: 29132899 DOI: 10.1016/j.jtcvs.2017.07.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 07/27/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Benny Weksler
- Division of Thoracic Surgery, University of Tennessee Health Science Center, Memphis, Tenn
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26
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Grocott HP. Understanding the efficacy of apneic oxygen insufflation during thoracoscopic lobectomy. J Thorac Cardiovasc Surg 2017; 154:2122. [PMID: 29132898 DOI: 10.1016/j.jtcvs.2017.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 11/20/2022]
Affiliation(s)
- Hilary P Grocott
- Department of Anesthesia, University of Manitoba, Winnipeg, Manitoba, Canada
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27
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Weksler B. During one-lung ventilation, K.I.S.S.—Keep It Simple Surgeons. J Thorac Cardiovasc Surg 2017; 154:367-368. [DOI: 10.1016/j.jtcvs.2017.03.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 03/10/2017] [Indexed: 11/16/2022]
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28
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Brown LM. The devil is in the detail. J Thorac Cardiovasc Surg 2017; 154:369. [PMID: 28433360 DOI: 10.1016/j.jtcvs.2017.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 03/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Lisa M Brown
- Division of Cardiothoracic Surgery, Department of Surgery, University of California Davis Health, Sacramento, Calif.
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