Abstract
ABSTRACT One lung ventilation (OLV) often results in trauma to the unventilated contralateral lung. This study aims to evaluate the effects of different OLV regimens on the injury of the unventilated contralateral lung to identify the best conditions for OLV. Forty rabbits were divided into five groups: a sham group, OLV group I (fraction of inspired oxygen (FIO2) 1.0, tidal volume (VT) 8mL/kg, respiratory rate (R) 40 breaths/min and inspiratory/expiratory ratio (I:E) 1:2), OLV group II (FIO2=1.0, VT 8mL/kg, R 40 breaths/min, I:E 1:2, and positive end-expiratory pressure (PEEP) 5 cm H2O), OLV group III (FIO2 1.0, VT 6mL/kg, R 40 breaths/min, I:E 1:2 and PEEP 5 cm H2O) and OLV group IV (FIO2 0.8, VT 6mL/kg, R 40 breaths/min, I:E 1:2 and PEEP 5 cm H2O). Animals from all OLV groups received two-lung ventilation (TLV) to establish a baseline, followed by one of the indicated OLV regimens. The rabbits in the sham group were intubated through trachea and ventilated with fresh air. Arterial blood gas samples were collected, lung injury parameters were evaluated, and the concentrations of TNF-α and IL-8 in bronchoalveolar lavage fluid (BALF) and pulmonary surfactant protein A (SPA) in the unventilated lung were also measured. In OLV group I, the unventilated left lung had higher TNF-α, IL-8 and lung injury score but lower SPA than the ventilated right lung. In OLV groups I to III, the concentrations of TNF-α, IL-8 and lung injury score in the left lung decreased but SPA increased. No differences in these parameters between OLV groups III and IV were observed. Strategic ventilation designed for OLV groups III and IV reduced OLV-induced injury of the non-ventilated contralateral lung in rabbits.
Highlights
One-lung ventilation (OLV) is carried out to allow a clearer view during thoracic surgical procedures (Liu et al, 2017) and to protect the normal lung from hemorrhage and abscess (Campos, 2002; Benumof, 1985)
The goal of the present study was to determine whether injury of the unventilated contralateral lung caused by One lung ventilation (OLV) could be reduced by strategic ventilation
The main finding from this study was that OLV groups III and IV generated less inflammatory responses and less severe injury in the unventilated contralateral lung compared with groups I and II
Summary
One-lung ventilation (OLV) is carried out to allow a clearer view during thoracic surgical procedures (Liu et al, 2017) and to protect the normal lung from hemorrhage and abscess (Campos, 2002; Benumof, 1985). Several studies have shown that the injury in the non-ventilated lung is greater than the one in the ventilated lung, there are studies reporting the opposite findings (Lohser and Slinger, 2015). There is an imperative need to identify the ventilation regimes that can maintain the advantages of OLV but reduce the OLV-induced injury to both, the ventilated lung and the unventilated contralateral lung. Called protective ventilatory approach, defined as the adjustment of the mode of ventilation, respiratory parameters and pharmacological application, has been developed to improve the outcomes, while minimizing the lung injury during ventilation (Keszler, 2017; Brower, et al, 2000; BrunBuisson et al, 2004; Dellinger et al, 2004). OLV-induced lung injury is influenced by several factors, including tidal volume (VT), positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FIO2)
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