Abstract
Although the application of positive end-expiratory pressure (PEEP) can alter cardiopulmonary physiology during one-lung ventilation (OLV), these changes have not been clearly elucidated. This study assessed the effects of different levels of PEEP on biventricular function, as well as pulmonary oxygenation during OLV. Thirty-six lung cancer patients received one PEEP combination of six sequences, consisting of 0 (PEEP_0), 5 (PEEP_5), and 10 cmH2O (PEEP_10), using a crossover design during OLV. The ratio of arterial oxygen partial pressure to inspired oxygen fraction (P/F ratio), systolic and diastolic echocardiographic parameters were measured at 20 min after the first, second, and third PEEP. P/F ratio at PEEP_5 was significantly higher compared to PEEP_0 (p = 0.014), whereas the P/F ratio at PEEP_10 did not show significant differences compared to PEEP_0 or PEEP_5. Left ventricular ejection fraction (LV EF) and right ventricular fractional area change (RV FAC) at PEEP_10 (EF, p < 0.001; FAC, p = 0.001) were significantly lower compared to PEEP_0 or PEEP_5. RV E/E’ (p = 0.048) and RV myocardial performance index (p < 0.001) at PEEP_10 were significantly higher than those at PEEP_0 or PEEP_5. In conclusion, increasing PEEP to 10 cmH2O decreased biventricular function, especially on RV function, with no further improvement on oxygenation compared to PEEP 5 cmH2O during OLV.
Highlights
One-lung ventilation (OLV), which is essential in thoracic surgery, induces ventilation/perfusion ratio (V/Q) mismatch by increasing intra-pulmonary shunts and dead space [1]
Application of positive-end expiratory pressure (PEEP) is an important factor in optimal OLV strategy, and several studies have investigated the amounts of PEEP that are beneficial during
A recent study showed that an “individualized” PEEP level measuring around 10 cmH2O improved pulmonary oxygenation during OLV [5]
Summary
One-lung ventilation (OLV), which is essential in thoracic surgery, induces ventilation/perfusion ratio (V/Q) mismatch by increasing intra-pulmonary shunts and dead space [1]. Large tidal volumes were applied to prevent unfavorable intraoperative atelectasis and improve gas exchange during OLV [2]. Several studies have shown that lung injury after thoracic surgery is associated with OLV [3,4]. An optimal strategy for OLV is needed for maintaining adequate gas exchange, and for protecting the lung. Application of positive-end expiratory pressure (PEEP) is an important factor in optimal OLV strategy, and several studies have investigated the amounts of PEEP that are beneficial during. A recent study showed that an “individualized” PEEP level measuring around 10 cmH2O improved pulmonary oxygenation during OLV [5]. In two-lung ventilation (TLV), aggressive mechanical ventilation using high levels of PEEP exceeding 10 cmH2O can restrict venous return and elevate right ventricular (RV) afterload, leading to limited left ventricular (LV) diastolic filling and decreased cardiac output [6]
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