Efficacy of intermittent ventilation performed in lungs on operated side for prevention of reexpansion pulmonary edema after pulmonary resection

Abstract

Objective To evaluate the efficacy of intermittent ventilation performed in lungs on the operated side for prevention of reexpansion pulmonary edema after pulmonary resection. Methods Forty patients of both sexes, aged 16-32 yr, with body mass index of 18-25 kg/m2, of ASA physical status Ⅰ or Ⅱ, scheduled for elective thoracoscope-assisted pulmonary resection, were randomly divided into 2 groups(n=20 each)using a random number table: control group(group C)and intermittent ventilation performed in lungs on the operated side group(group V). After induction of anesthesia, the patients were tracheally intubated and mechanically ventilated.After correct positioning was confirmed by fiberoptic bronchoscopy, one-lung ventilation was performed instead.One-lung ventilation was performed routinely in group C. In group V, the lung on the operated side was ventilated intermittently for 30 s with the tidal volume set at 2 ml/kg and respiration rate at 20 bpm, the bronchial tube was then opened, and the process was repeated at 10 min intervals until the diseased tissues were removed.After resection of diseased tissues, the specimens of normal tissues around the area were obtained for determination of the expression of aquaporin 1(AQP-1)and AQP-5 in lung tissues.The development of pulmonary atelectasis, hyoxemia and reexpansion pulmonary edema was recorded within 24 h after surgery. Results Compared with group C, AQP-1 and AQP-5 expression was significantly up-regulated, the incidence of atelectasis and reexpansion pulmonary edema was decreased within 24 h after surgery, while no significant change was found in the incidence of hyoxemia in group V. Conclusion Intermittent ventilation performed in lungs on the operated side can effectively prevent the development of reexpansion pulmonary edema during one-lung ventilation in the patients undergoing pulmonary resection. Key words: Respiration, artificial; Pulmonary edema; Postoperative complications