Abstract
BackgroundThe efficacy of protective ventilation in acute lung injury has validated its use in the operating room for patients undergoing thoracic surgery with one-lung ventilation (OLV). The purpose of this study was to investigate the effects of two different modes of ventilation using low tidal volumes: pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on oxygenation and airway pressures during OLV.MethodsWe studied 41 patients scheduled for thoracoscopy surgery. After initial two-lung ventilation with VCV patients were randomly assigned to one of two groups. In one group OLV was started with VCV (tidal volume 6 mL/kg, PEEP 5) and after 30 minutes ventilation was switched to PCV (inspiratory pressure to provide a tidal volume of 6 mL/kg, PEEP 5) for the same time period. In the second group, ventilation modes were performed in reverse order. Airway pressures and blood gases were obtained at the end of each ventilatory mode.ResultsPaO2, PaCO2 and alveolar-arterial oxygen difference did not differ between PCV and VCV. Peak airway pressure was significantly lower in PCV compared with VCV (19.9 ± 3.8 cmH2O vs 23.1 ± 4.3 cmH2O; p < 0.001) without any significant differences in mean and plateau pressures.ConclusionsIn patients with good preoperative pulmonary function undergoing thoracoscopy surgery, the use of a protective lung ventilation strategy with VCV or PCV does not affect the oxygenation. PCV was associated with lower peak airway pressures.
Highlights
Anesthesia for thoracic surgery routinely involves one lung ventilation (OLV) to provide optimum surgical operating conditions and to isolate and protect the lungs during the procedure
one-lung ventilation (OLV) traditionally has been performed with tidal volumes (VT) that are equal to those being used on two lung ventilation (TLV) [2]
VT used by clinicians have progressively decreased from more than 12-15 ml/kg to less than 9 ml/kg actual body weight [3,4,5,6]. This practice is based on several studies that showed that mechanical ventilation using VT of no more than 6 ml/kg resulted in reduction of systemic inflammatory markers
Summary
Anesthesia for thoracic surgery routinely involves one lung ventilation (OLV) to provide optimum surgical operating conditions and to isolate and protect the lungs during the procedure. This practice may associate with an important impairment in gas exchange, in patients with previous lung disease [1]. VT used by clinicians have progressively decreased from more than 12-15 ml/kg to less than 9 ml/kg actual body weight [3,4,5,6] This practice is based on several studies that showed that mechanical ventilation using VT of no more than 6 ml/kg resulted in reduction of systemic inflammatory markers, The use of low VT has been recommended in patients during OLV [10]. The purpose of this study was to investigate the effects of two different modes of ventilation using low tidal volumes: pressure controlled ventilation (PCV) vs. volume controlled ventilation (VCV) on oxygenation and airway pressures during OLV
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