Effects of different modes of one-lung ventilation on respiratory physiology and oxidative stress in thoracoscopic radical resection of lung cancer

Abstract

Objective To explore the effects of two different modes for one-lung ventilation on airway pressure and oxidative stress factors during thoracoscopic radical resection of right lung cancer. Methods Sixty-two patients who needed one-lung ventilation after thoracoscopic radical resection of right lung cancer were divided into volume-controlled ventilation (VCV) group and pressure-controlled ventilation (PCV) group by random number table.VCV was used in both groups during dual lung ventilation.In VCV group, tidal volume was 6 ml/kg, positive end-expiratory pressure was 0 cmH2O (1 cmH2O=0.098 kPa). In PCV group, VCV mode was firstly used to regulate airway pressure to tidal volume at 6 ml/kg, then PCV mode was used, positive end-expiratory pressure was 0 cmH2O, and ventilation frequency was adjusted to maintain the value of end-tidal carbon dioxide partial pressure at 30-45 mmHg (1 mmHg=0.133 kPa). Radial artery blood was collected for blood gas analysis at 10 minutes (T1) before dual lung ventilation and 30 minutes (T2), 60 minutes (T3) and 120 minutes (T4) after one-lung ventilation.Malondialdehyde (MDA) and superoxide dismutase (SOD) in radial artery blood serum were measured at T1, T3 and T4 time points in the two groups. Results There was no significant difference in hemodynamic parameters between the two groups at different time points.At T3 and T4, the peak airway pressures of PCV group were (22.00±4.44) and (21.68±4.55) cmH2O, which were significantly lower than those of VCV group [(25.00±4.14), (25.00±4.03) cmH2O]. At T3 and T4, MDA of PCV group was (6.64±2.15), (7.11±1.50) μmol/L, which was significantly lower than that of VCV group [(7.31±2.09), (8.00±1.83) μmol/L], and SOD of PCV group was (39.42±15.36), (37.49±13.02) U/ml, which was significantly higher than that of VCV group [(35.94±8.47), (31.72±7.83) U/ml]. There was no significant difference in arterial partial pressure of oxygen and carbon dioxide between the two groups during one-lung ventilation. Conclusions PCV in thoracoscopic radical resection of lung cancer is helpful to reduce peak airway pressure and levels of oxidative stress factors, which may be helpful to reduce airway injury. Key words: One-lung ventilation; Volume-controlled ventilation; Pressure-controlled ventilation; Blood gas analysis; Oxidative stress mediators