Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in patients with low diffusion capacity of lung for carbon monoxide: a crossover study

Abstract

Study ObjectiveTo investigate the effects of a 1:1 inspiratory-to-expiratory (I:E) ventilation ratio on oxygenation and respiratory mechanics during one-lung ventilation (OLV) in patients with low diffusion capacity of lung for carbon monoxide (DLCO). DesignProspective, randomized, crossover study. SettingOperating room, university hospital. PatientsTwenty-six patients with a preoperative DLCO less than 80% who were scheduled for lung lobectomy requiring OLV under general anesthesia. InterventionsIn the first group (n = 13), OLV was begun with a 1:1 I:E ratio, which was switched to a 1:2 I:E ratio after 30minutes. In the second group (n = 13), the modes of ventilation were performed in the opposite order. Pressure-controlled ventilation with 5 cm H2O of positive end-expiratory pressure and a tidal volume of 5 to 8mL/kg was applied during OLV. MeasurementsArterial and central venous blood gas analyses were recorded and used to calculate intrapulmonary shunt fraction and physiologic dead space. These measurements were taken at 4 time points: 10minutes after two-lung ventilation in the lateral decubitus position, 30minutes after initiation of OLV, 30minutes after switching the I:E ratio, and 10minutes after two-lung ventilation was resumed. Main ResultsThere was no difference in arterial oxygen tension during OLV between the 2 groups (P = .429). Arterial carbon dioxide tension and peak airway pressure were lower in the 1:1 group than in the 1:2 group (P = .003; P = .008). Physiologic dead space was also decreased in the 1:1 I:E ratio group (P = .003). Mean airway pressure and dynamic compliance were higher in the 1:1 group (P = .003; P = .007). ConclusionsPressure-controlled ventilation with a 1:1 I:E ventilation ratio did not improve oxygenation in patients with low DLCO during OLV compared with a 1:2 I:E ventilation ratio. However, it did provide benefits in terms of respiratory mechanics and increased the efficiency of alveolar ventilation during OLV.