Abstract
ObjectiveThe 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.MethodsFifty-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.ResultsPatients 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.ConclusionAOI 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 registrationChiCTR-IOR-17011037. Registered on 31 March 2017.
Highlights
As a non-physiological ventilation mode, OLV causes hypoxemia, acute lung injury (ALI) and even acute respiratory distress syndrome (ARDS)
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, postoperative hospital stay and postoperative pulmonary complications was evaluated
Oxygenation index after OLV One lung ventilation resulted in an decrease in the measured of oxygenation index(OI) after OLV
Summary
As a non-physiological ventilation mode, OLV causes hypoxemia, acute lung injury (ALI) and even acute respiratory distress syndrome (ARDS). It has been reported that the selective oxygen supply of non-ventilated lungs at a flow rate of 5 L/min through the fiberoptic bronchoscope significantly improves oxygenation while not affects surgical operations [6], this method is called apneic oxygen insufflation(AOI).Literature [6, 7] and our previous studies [8] have shown that AOI with oxygen flow in 5 L/min can improve arterial oxygenation function and reduce the intrapulmonary shunt rate during OLV, and moderating lung collapse with highest satisfaction of surgeons It has not been reported the effects of AOI on oxygenation function, inflammation and oxygenation stress response after OLV and long-term clinical outcome, we were interested to explore the potential benefits of AOI for patients undergoing thoracic surgery
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