1
|
Wang Y, Huang W, He M, Peng L, Cai M, Yuan C, Hu Z, Li K. [Inverse ratio ventilation combined with PEEP in infants undergoing thoracoscopic surgery with one lung ventilation for lung cystadenomas: a randomized control trial of 63 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:1008-1012. [PMID: 32895160 DOI: 10.12122/j.issn.1673-4254.2020.07.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the effect of inverse ratio ventilation (IRV) combined with positive end-expiratory pressure (PEEP) in infants undergoing thoracoscopic surgery with single lung ventilation (OLV) for lung cystadenomas. METHODS A total of 66 infants undergoing thoracoscopic surgery with OLV for lung cystadenomas in our hospital from February, 2018 to February, 2019 were randomized into conventional ventilation groups (group N, n=33) and inverse ventilation group (group R, n=33). Hemodynamics and respiratory parameters of the infants were recorded and arterial blood gas analysis was performed at 15 min after two lung ventilation (TLV) (T1), OLV30 min (T2), OLV60 min (T3), and 15 min after recovery of TLV (T4). Bronchoalveolar lavage fluid was collected before and after surgery to detect the expression level of advanced glycation end product receptor (RAGE). RESULTS Sixty-three infants were finally included in this study. At T2 and T3, Cdyn, PaO2 and OI in group R were significantly higher (P < 0.05) and Ppeak, PaCO2 and PA-aO2 were significantly lower than those in group N (P < 0.05). There was no significant difference in HR or MAP between the two groups at T2 and T3 (P > 0.05). The level of RAGE significantly increased after the surgery in both groups (P < 0.05), and was significantly lower in R group than in N group (P < 0.05). CONCLUSIONS In infants undergoing thoracoscopic surgery with OLV for pulmonary cystadenoma, appropriate IRV combined with PEEP does not affect hemodynamic stability and can increases pulmonary compliance, reduce the peak pressure, and improve oxygenation to provide pulmonary protection.
Collapse
Affiliation(s)
- Yun Wang
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Weijian Huang
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Mudan He
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Lingli Peng
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Mingyang Cai
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Chao Yuan
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Zurong Hu
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| | - Kunwei Li
- Department of Anesthesiology, Guangdong Women and Children's Hospital, Guangzhou 511400, China
| |
Collapse
|
2
|
Pulmonary effects of remote ischemic preconditioning in a porcine model of ventilation-induced lung injury. Respir Physiol Neurobiol 2019; 259:111-118. [DOI: 10.1016/j.resp.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/19/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022]
|
3
|
Fiorelli S, Defraia V, Cipolla F, Menna C, Ibrahim M, Andreetti C, Simmaco M, Rocco M, Rendina EA, Borro M, Massullo D. Short-term one-lung ventilation does not influence local inflammatory cytokine response after lung resection. J Thorac Dis 2018; 10:1864-1874. [PMID: 29707341 DOI: 10.21037/jtd.2018.03.50] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background One-lung ventilation (OLV) is a ventilation procedure used for pulmonary resection which may results in lung injury. The aim of this study was to evaluate the local inflammatory cytokine response from the dependent lung after OLV and its correlation to VT. The secondary aim was to evaluate the clinical outcome of each patient. Methods Twenty-eight consecutive patients were enrolled. Ventilation was delivered in volume-controlled mode with a VT based on predicted body weight (PBW). 5 cmH2O positive end-expiratory pressure (PEEP) and FiO2 0.5 were applied. Bronchoalveolar lavage (BAL) was performed in the dependent lung before and after OLV. The levels of pro-inflammatory interleukins (IL-1α, IL-1β, IL-6, IL-8), tumor necrosis factor alpha (TNFα), vascular endothelial growth factor (VEGF), endothelial growth factor (EGF), monocyte chemoattractant protein-1 (MCP-1) and anti-inflammatory cytokines, such as interleukins (IL-2, IL-4, IL-10) and interferon (IFN-γ), were evaluated. Subgroup analysis: to analyze the VT setting during OLV, all patients were ventilated within a range of 5-10 mL/kg. Thirteen patients, classified as a conventional ventilation (CV) subgroup, received 8-10 mL/kg, while 15 patients, classified as a protective ventilation (PV) subgroup, received 5-7 mL/kg. Results Cytokine BAL levels after surgery showed no significant increase after OLV, and no significant differences were recorded between the two subgroups. The mean duration of OLV was 64.44±21.68 minutes. No postoperative respiratory complications were recorded. The mean length of stay was for 4.00±1.41 days in the PV subgroup and 4.45±2.07 days in the CV group; no statistically significant differences were recorded between the two subgroups (P=0.511). Conclusions Localized inflammatory cytokine response after OLV was not influenced by the use of different VT. Potentially, the application of PEEP in both ventilation strategies and the short duration of OLV could prevent postoperative complications.
Collapse
Affiliation(s)
- Silvia Fiorelli
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| | - Veronica Defraia
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| | - Fabiola Cipolla
- The Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Italy
| | - Cecilia Menna
- Department of Thoracic Surgery; Sapienza University of Rome, Italy
| | - Mohsen Ibrahim
- Department of Thoracic Surgery; Sapienza University of Rome, Italy
| | | | - Maurizio Simmaco
- The Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Italy
| | - Monica Rocco
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| | | | - Marina Borro
- The Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Italy
| | - Domenico Massullo
- Department of Anesthesiology and Intensive Care, Sapienza University of Rome, Italy
| |
Collapse
|
4
|
El Tahan MR, Pasin L, Marczin N, Landoni G. Impact of Low Tidal Volumes During One-Lung Ventilation. A Meta-Analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2017; 31:1767-1773. [DOI: 10.1053/j.jvca.2017.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 12/18/2022]
|
5
|
Experimental left pneumonectomy in pigs: procedure and management. J Surg Res 2015; 198:208-16. [DOI: 10.1016/j.jss.2015.05.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/15/2015] [Accepted: 05/22/2015] [Indexed: 11/19/2022]
|
6
|
Theroux MC, Olivant Fisher A, Rodriguez ME, Brislin RP, Reichard KW, Shah SA, McCoy M, Brown M, Dabney KW, Mackenzie WG, Katz DA, Shaffer TH. Prophylactic methylprednisolone to reduce inflammation and improve outcomes from one lung ventilation in children: a randomized clinical trial. Paediatr Anaesth 2015; 25:587-94. [PMID: 25557228 PMCID: PMC4414674 DOI: 10.1111/pan.12601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND One lung ventilation (OLV) results in inflammatory and mechanical injury, leading to intraoperative and postoperative complications in children. No interventions have been studied in children to minimize such injury. OBJECTIVE We hypothesized that a single 2-mg·kg(-1) dose of methylprednisolone given 45-60 min prior to lung collapse would minimize injury from OLV and improve physiological stability. METHODS Twenty-eight children scheduled to undergo OLV were randomly assigned to receive 2 mg·kg(-1) methylprednisolone (MP) or normal saline (placebo group) prior to OLV. Anesthetic management was standardized, and data were collected for physiological stability (bronchospasm, respiratory resistance, and compliance). Plasma was assayed for inflammatory markers related to lung injury at timed intervals related to administration of methylprednisolone. RESULTS Three children in the placebo group experienced clinically significant intraoperative and postoperative respiratory complications. Respiratory resistance was lower (P = 0.04) in the methylprednisolone group. Pro-inflammatory cytokine IL-6 was lower (P = 0.01), and anti-inflammatory cytokine IL-10 was higher (P = 0.001) in the methylprednisolone group. Tryptase, measured before and after OLV, was lower (P = 0.03) in the methylprednisolone group while increased levels of tryptase were seen in placebo group after OLV (did not achieve significance). There were no side effects observed that could be attributed to methylprednisolone in this study. CONCLUSIONS Methylprednisolone at 2 mg·kg(-1) given as a single dose prior to OLV provides physiological stability to children undergoing OLV. In addition, methylprednisolone results in lower pro-inflammatory markers and higher anti-inflammatory markers in the children's plasma.
Collapse
Affiliation(s)
- Mary C. Theroux
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA,Department of Anesthesiology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA,Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA
| | | | - Maria E. Rodriguez
- Nemours Biomedical Research, Wilmington, USA,Division of Clinical Pharmacology, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, USA
| | | | - Kirk W. Reichard
- Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| | - Suken A. Shah
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| | - Matt McCoy
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA,Nurse Anesthesia Program, Villanova University, Villanova, USA
| | - Melinda Brown
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| | - Kirk W. Dabney
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| | - William G. Mackenzie
- Department of Orthopedic Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| | - Douglas A. Katz
- Department of Surgery, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| | - Thomas H. Shaffer
- Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, USA,Nemours Biomedical Research, Wilmington, USA,Nemours Research Lung Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, USA
| |
Collapse
|
7
|
Ventilation with lower tidal volumes for critically ill patients without the acute respiratory distress syndrome: a systematic translational review and meta-analysis. Curr Opin Crit Care 2014; 20:25-32. [PMID: 24275571 DOI: 10.1097/mcc.0000000000000044] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW There is convincing evidence for benefit from lung-protective mechanical ventilation with lower tidal volumes in patients with the acute respiratory distress syndrome (ARDS). It is uncertain whether this strategy benefits critically ill patients without ARDS as well. This manuscript systematically reviews recent preclinical studies of ventilation in animals with uninjured lungs, and clinical trials of ventilation in ICU patients without ARDS on the association between tidal volume size and pulmonary complications and outcome. RECENT FINDINGS Successive preclinical studies almost without exception show that ventilation with lower tidal volumes reduces the injurious effects of ventilation in animals with uninjured lungs. This finding is in line with results from recent trials in ICU patients without ARDS, demonstrating that ventilation with lower tidal volumes has a strong potential to prevent development of pulmonary complications and maybe even to improve survival. However, evidence mostly comes from nonrandomized clinical trials, and concerns are expressed regarding unselected use of lower tidal volumes in the ICU, that is, in all ventilated critically ill patients, since this strategy could also increase needs for sedation and/or neuromuscular blockade, and maybe even cause respiratory muscle fatigue. These all then could in fact worsen outcome, possibly counteracting the beneficial effects of ventilation with lower tidal volumes. SUMMARY Ventilation with lower tidal volumes protects against pulmonary complications, but well-powered randomized controlled trials are urgently needed to determine whether this ventilation strategy truly benefits all ventilated ICU patients without ARDS.
Collapse
|
8
|
Abstract
There are 3 surgical procedures that patients with cerebral palsy (CP) undergo that may be considered major procedures: femoral osteotomies combined with pelvic osteotomies, spine fusion, and intrathecal baclofen pump implant for the treatment of spasticity. Many complications are known to occur at a higher rate in this population, and some may be avoided with prior awareness of the preoperative pathophysiology of the patient with CP.
Collapse
Affiliation(s)
- Mary C Theroux
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Post Office Box 269, Wilmington, DE 19899, USA; Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, 111 S 11th Street, PA 19107, USA.
| | - Sabina DiCindio
- Department of Anesthesiology and Critical Care Medicine, Nemours/Alfred I. duPont Hospital for Children, Post Office Box 269, Wilmington, DE 19899, USA; Department of Pediatrics, Jefferson Medical College, Thomas Jefferson University, Philadelphia, 111 S 11th Street, PA 19107, USA
| |
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW This review will analyze the risk factors of acute lung injury (ALI) in patients undergoing thoracic surgery. Evidence for the occurrence of lung injury following mechanical ventilation and one-lung ventilation (OLV) and the strategies to avoid it will also be discussed. RECENT FINDINGS Post-thoracotomy ALI has become one of the leading causes of operative death. The pathogenesis of ALI implicates a multiple-hit sequence of various triggering factors (e.g. preoperative conditions, surgery-induced inflammation, ventilator-induced injury, fluid overload, and transfusion). Conventional ventilation during OLV is performed with high tidal volumes equal to those being used in two-lung ventilation, high FiO(2), and without positive end-expiratory pressure. This practice was originally recommended to improve oxygenation and decrease shunt fraction during OLV. However, a number of recent studies using experimental models or human patients have shown low tidal volumes to be associated with a decrease in inflammatory mediators and a reduction in pulmonary postoperative complications. However, the application of such protective strategies could be harmful if not still properly used. SUMMARY The goal of ventilation is to minimize lung trauma by avoiding overdistension and repetitive alveolar collapse, while providing adequate oxygenation. Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also involves positive end-expiratory pressure, lower FiO(2), recruitment maneuvers, and lower ventilatory pressures.
Collapse
|
10
|
Olivant Fisher A, Husain K, Wolfson MR, Hubert TL, Rodriguez E, Shaffer TH, Theroux MC. Hyperoxia during one lung ventilation: inflammatory and oxidative responses. Pediatr Pulmonol 2012; 47:979-86. [PMID: 22431368 PMCID: PMC3888791 DOI: 10.1002/ppul.22517] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 12/05/2011] [Indexed: 12/22/2022]
Abstract
BACKGROUND It is common practice during one lung ventilation (OLV) to use 100% oxygen, although this may cause hyperoxia- and oxidative stress-related lung injury. We hypothesized that lower oxygen (FiO(2) ) during OLV will result in less inflammatory and oxidative lung injury and improved lung function. METHODS Twenty pigs (8.88 ± 0.84 kg; 38 ± 4.6 days) were assigned to either the hyperoxia group (n = 10; FiO(2) = 100%) or the normoxia group (n = 10; FiO(2) < 50%). Both groups were subjected to 3 hr of OLV. Blood samples were tested for pro-inflammatory cytokines and lung tissue was tested for these cytokines and oxidative biomarkers. RESULTS There were no differences between groups for partial pressure of CO(2) , tidal volume, end-tidal CO(2) , plasma cytokines, or respiratory compliance. Total respiratory resistance was greater in the hyperoxia group (P = 0.02). There were higher levels of TNF-α, IL-1β, and IL-6 in the lung homogenates of the hyperoxia group than in the normoxia group (P ≤ 0.01, 0.001, and 0.001, respectively). Myeloperoxidase and protein carbonyls (PC) were higher (P = 0.03 and P = 0.01, respectively) and superoxide dismutase (SOD) was lower in the lung homogenates of the hyperoxia group (P ≤ 0.001). CONCLUSION Higher myeloperoxidase, PC, and cytokine levels, and lower SOD availability indicate a greater degree of injury in the lungs of the hyperoxia animals, possibly from using 100% oxygen. In this translational study using a pig model, FiO(2) ≤ 50% during OLV reduced hyperoxic injury and improved function in the lungs.
Collapse
Affiliation(s)
- Alicia Olivant Fisher
- Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE19803, USA.
| | | | | | | | | | | | | |
Collapse
|
11
|
Witt L, Osthaus WA, Schröder T, Teich N, Dingemann C, Kübler J, Böthig D, Sümpelmann R. Single-lung ventilation with carbon dioxide hemipneumothorax: hemodynamic and respiratory effects in piglets. Paediatr Anaesth 2012; 22:793-8. [PMID: 22171739 DOI: 10.1111/j.1460-9592.2011.03766.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Video-assisted thoracoscopic surgery (VATS) has become a standard procedure in pediatric surgery. To facilitate surgical access, the dependent lung has to collapse using intrathoracic carbon dioxide insufflation and/or single-lung ventilation. These procedures can induce hemodynamic deteriorations in adults. The potential impacts of single-lung ventilation in combination with capnothorax on hemodynamics in infants have never been studied before. AIM We conducted a randomized experimental study focusing on hemodynamic and respiratory changes during single-lung ventilation with or without capnothorax in a pediatric animal model. METHODS Twelve piglets were randomly assigned to receive single-lung ventilation with (SLV-CO(2) ) or without (SLV) capnothorax with an insufflation pressure of 5 mmHg for a period of two hours. Before, during, and after single-lung ventilation, hemodynamic and respiratory parameters were measured. RESULTS Although mean arterial pressure remained stable during the course of the study and no critical incidents were monitored, cardiac index (CI) decreased significantly with SLV-CO(2) (baseline 3.6 ± 1.6 l · min(-1) · m(-2) vs 2.9 ± 1.1 l · min(-1) · m(-2) at 120 min, P < 0.05). Furthermore, global end-diastolic volume and intrathoracic blood volume (ITBV) decreased as well significantly with SLV-CO(2) , causing a significant between-group difference in ITBV (P < 0.05). CONCLUSIONS Despite a decrease in CI and preload parameters, the combination of single-lung ventilation and low-pressure capnothorax was well tolerated in piglets and could justify further clinical studies to be performed in infants and children focusing on hemodynamic and respiratory changes during VATS.
Collapse
Affiliation(s)
- Lars Witt
- Clinic of Anaesthesiology, Hannover Medical School, Hannover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
12
|
Leite CF, Calixto MC, Toro IFC, Antunes E, Mussi RK. Characterization of Pulmonary and Systemic Inflammatory Responses Produced by Lung Re-expansion After One-Lung Ventilation. J Cardiothorac Vasc Anesth 2012; 26:427-32. [DOI: 10.1053/j.jvca.2011.09.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Indexed: 12/20/2022]
|
13
|
Bhatia R, Shaffer TH, Hossain J, Fisher AO, Horner LM, Rodriguez ME, Penfil S, Theroux MC. Surfactant administration prior to one lung ventilation: physiological and inflammatory correlates in a piglet model. Pediatr Pulmonol 2011; 46:1069-78. [PMID: 21618717 PMCID: PMC3320852 DOI: 10.1002/ppul.21485] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2010] [Revised: 03/22/2011] [Accepted: 03/26/2011] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To test the hypothesis that surfactant, when given prophylactically during one lung ventilation (OLV), improves physiological stability and reduces inflammation. METHODS Prospective controlled animal study. After 30 min of mechanical ventilation, surfactant was administered to the left lung of the treatment group. Right lung mechanical ventilation continued for 3 hr, after which the left lung was unblocked. Bilateral mechanical ventilation was continued for 30 min thereafter. Physiological parameters and biomarkers of inflammation in plasma, lung tissue homogenates, and bronchoalveolar lavage (BAL) were measured. MEASUREMENTS AND MAIN RESULTS Oxygenation improved in the surfactant group, reaching statistical significance at 3 hr of OLV and again after 30 min of bilateral mechanical ventilation following the OLV. Plasma levels of interleukin (IL)-1 β, IL-6, and tumor necrosis factor (TNF)-α showed a trend for reduction. The lung homogenates from the ventilated lungs had significantly lower levels of IL-1 β (P < 0.01) and IL-6 (P < 0.01). The BAL specimen showed an overall reduction in the cytokine levels; IL-1 β was significantly lower in the ventilated lungs (P < 0.01). CONCLUSIONS Surfactant administration improves oxygenation and decreases inflammation, as evidenced by a decrease in several inflammatory cytokines both in the plasma and lungs of a piglet model of OLV.
Collapse
|
14
|
Abstract
PURPOSE OF REVIEW Hypoxemia during one-lung ventilation (OLV) has become less common; however, it may still occur in about 10% of cases. We review recent developments which may affect the incidence and treatment of hypoxemia during OLV. RECENT FINDINGS Changes in surgical techniques are affecting oxygenation during OLV. The increased use of the supine position may adversely affect the prevalence of hypoxemia, whereas the increased application of thoracoscopic techniques is limiting the treatment options. Treatment options such as global or selective recruitment maneuvers and drug effects of dexmedetomidine and epoprostenol on arterial oxygenation during OLV are discussed. Capnometry prior to, or early during OLV, may in fact be able to predict the degree of hypoxemia during OLV. Persistent controversies surrounding the effect of epidural anesthesia, ventilatory modalities and gravity are reviewed. SUMMARY Interesting concepts have emerged from case reports and small studies on the treatment and prediction of hypoxemia during OLV. Definitive studies on the most effective ventilatory mode remain elusive. End-organ effects of OLV are an exciting new concept that may shape clinical practice and research going forward.
Collapse
|
15
|
Bibliography. Current world literature. Thoracic anesthesia. Curr Opin Anaesthesiol 2011; 24:111-3. [PMID: 21321525 DOI: 10.1097/aco.0b013e3283433a20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
16
|
|