One-lung Ventilation In Patients Research Articles

Continuous Positive Airway Pressure versus Differential Lung Ventilation during One Lung Ventilation for Thoracic Surgery.

One lung ventilation (OLV) is a technique used during lung resection surgery to facilitate optimal surgical conditions. However, this may result in severe hypoxemia due to the right-to-left shunt created in the collapsed lung. Several techniques are used to overcome hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV) or split lung ventilation (SLV). In this study, we compared the efficacy of CPAP to DLV during video-assisted thoracoscopic (VATS) lung resection. In this single-center randomized controlled, cross-over study, each patient acted as his control as well as the study. Patients crossed over from SLV to CPAP (or vice versa) with an interval period during which only OLV was used (control period). The primary objective of the study was to observe the changes in oxygenation, ventilation, and the surgeons' perception of the surgical field using CPAP or SLV to the non-ventilated lung during the period of OLV in patients undergoing thoracic surgery. The study revealed that oxygenation was significantly better when using SLV to the non-ventilated lung during the period of OLV (P = 0.03). However, the surgeon found a significantly better surgical field when applying CPAP to the surgical field. The study showed that using SLV to the non-ventilated lung during the period of OLV was superior in terms of oxygenation, although it interfered more with the surgical field.

Continuous positive airway pressure combined with small-tidal-volume ventilation on arterial oxygenation and pulmonary shunt during one-lung ventilation in patients undergoing video-assisted thoracoscopic lobectomy: A randomized, controlled study.

One-lung ventilation (OLV) is frequently applied during video-assisted thoracoscopic surgery (VATS) airway management to collapse and isolate the nondependent lung (NL). OLV can give rise to hypoxemia as a result of the pulmonary shunting produced. Our study aimed to assess the influence of continuous positive airway pressure (CPAP) combined with small-tidal-volume ventilation on improving arterial oxygenation and decreasing pulmonary shunt rate (QS/QT) without compromising surgical field exposure during OLV. Forty-eight patients undergoing scheduled VATS lobectomy were enrolled in this research and allocated into three groups at random: C group (conventional ventilation, no NL ventilation intervention was performed), LP group (NL was ventilated with lower CPAP [2 cmH2O] and a 40-60 mL tidal volume [TV]), and HP group (NL was ventilated with higher CPAP [5 cmH2O] and a 60-80 mL TV). Record the blood gas analysis data and calculate the QS/QT at the following time: at the beginning of the OLV (T0), 30 min after OLV (T1), and 60 min after OLV (T2). Surgeons blinded to ventilation techniques were invited to evaluate the surgical fields. The demography data of the three groups were consistent with the surgical data. At T1, PaO2 in the HP group was substantially higher compared to the C group (P < 0.05), while there was no significant difference in the LP group (P > 0.05). At T1-T2, PaCO2 in the LP and HP groups was significantly less than that in the C group (P < 0.05). At T1, the QS/QT values of groups C, LP, and HP were 29.54 ± 6.89%, 22.66 ± 2.08%, and 19.64 ± 5.76%, respectively, and the QS/QT values in the LP and HP groups markedly reduced (P < 0.01). The surgical field's evaluation by the surgeon among the three groups was not notable (P > 0.05). CPAP combined with small-tidal-volume ventilation effectively improved arterial oxygenation and reduced QS/QT and PaCO2 without compromising surgical field exposure during OLV. Among them, 5 cmH2O CPAP + 60-80 ml TV ventilation had a better effect on improving oxygenation.

Use of an Endobronchial Blocker in a Patient with Tracheobronchial Anomaly for Minimally Invasive Cardiac Surgery: A Case Report.

Tracheal bronchi (TB) is a rare anomaly and is usually asymptomatic. Although it is generally not a problem when a single lumen tube is used, it may cause ventilation difficulties in the intraoperative period in procedures requiring one lung ventilation, such as minimally invasive cardiac surgery. Therefore, these difficulties may cause intraoperative and postoperative complications. While a double-lumen tube is recommended as the primary choice for one-lung ventilation in patients with TB, bronchial blockers can be used to avoid the need for tube exchange in patients who will remain intubated in the postoperative period.

Pressure-controlled versus Volumecontrolled Ventilation during One Lung Ventilation for Empyema Thoracis: A Randomised Control Trial

Pressure-controlled versus Volumecontrolled Ventilation during One Lung Ventilation for Empyema Thoracis: A Randomised Control Trial

Transcutaneous electrical acupoint stimulation improves pulmonary function by regulating oxidative stress during one-lung ventilation in patients with lung cancer undergoing thoracoscopic surgery: a randomized controlled trial

BackgroundOur aim was to evaluate the efficacy of transcutaneous electrical acupoint stimulation (TEAS) on oxidative stress induced by one-lung ventilation, lung function, and postoperative quality of recovery in patients with lung cancer.MethodsThe participants (n = 80) were assigned to the sham group and TEAS group. TEAS on bilateral Feishu (BL13), Zusanli (ST36), and Hegu (L14) was performed 30 minutes before induction of anesthesia and continued until the end of the surgery. In the sham group, the same acupoints were selected without electrical stimulation. PaO2/FiO2, intrapulmonary shunt ratio (Qs/Qt), alveolar-arterial oxygen tension (A-aDO2), and respiratory index (RI) were calculated to evaluate lung function before one-lung ventilation (T0), 30 min after one-lung ventilation (T1), 1 h after one-lung ventilation (T2), and 10 min after resuming two-lung ventilation (T3). The levels of malondialdehyde (MDA) and superoxide dismutase (SOD) were detected to estimate oxidative stress at T0, T1, T2, and T3. Secondary outcomes included removal time of thoracic drainage tube, duration of intensive care unit (ICU) stay, length of postoperative hospitalization, the incidence of postoperative pulmonary complications, and the Quality of Recovery-15 (QoR-15) score on postoperative day 1 and 2.ResultsTEAS significantly increased PaO2/FiO2 at T1 and T2, while Qs/Qt, A-aDO2, and RI decreased remarkably from T1 to T3 (P < 0.05). Meanwhile, TEAS obviously decreased MDA and increased SOD activity at T2 and T3 (P < 0.05). Furthermore, TEAS also markedly shortened the length of ICU stay and hospital stay after surgery, whereas the QoR-15 score on postoperative day 1 and 2 was significantly higher (P < 0.05).ConclusionsTEAS could reduce oxidative lung injury during one-lung ventilation, thereby protecting pulmonary function and effectively accelerating the early recovery of patients with lung cancer.Trial registrationChinese Clinical Trial Registry (ChiCTR2000038243).

Association between Oxygen Reserve index and arterial partial pressure of oxygen during one-lung ventilation: a retrospective cohort study.

We aimed to investigate the association between the Oxygen Reserve index (ORi) and arterial partial pressure of oxygen (PaO2) during one-lung ventilation in patients who underwent non-cardiac thoracic surgery requiring one-lung ventilation. This retrospective study assessed the eligibility of 578 adult patients who underwent elective non-cardiac thoracic surgery requiring one-lung ventilation at a tertiary hospital, and their electronic medical records were reviewed. The ORi monitor was used in all patients during anesthesia, and arterial blood gas analysis was routinely performed 15 min after the initiation of one-lung ventilation. The primary endpoint was the association between ORi and PaO2 which were measured simultaneously during one-lung ventilation. We also investigated the risk factors for PaO2 less than 150 mmHg during one-lung ventilation. Total of 554 patient were included in the analysis. The ORi value measured 15 min after the start of one-lung ventilation was significantly associated with PaO2 in the linear regression model (r2 = 0.5752, P < 0.001), and 0.27 of the ORi value could distinguish PaO2 ≥ 150 mmHg (sensitivity 0.909, specificity 0.932). Risk factors for PaO2 < 150 mmHg during one-lung ventilation included a lower ORi, older age, higher body mass index, left-sided one-lung ventilation, and lower hemoglobin concentrations. This study suggested that ORi could provide useful information on arterial oxygenation even during one-lung ventilation for non-cardiac thoracic surgery.

Effect of permissive hypercarbia on lung oxygenation during one-lung ventilation and postoperative pulmonary complications in patients undergoing thoracic surgery: A prospective randomised controlled trial.

The effect of hypercarbia on lung oxygenation during thoracic surgery remains unclear. To investigate the effect of hypercarbia on lung oxygenation during one-lung ventilation in patients undergoing thoracic surgery and evaluate the incidence of postoperative pulmonary complications. Prospective randomised controlled trial. A tertiary university hospital in the Republic of Korea from November 2019 to December 2020. Two hundred and ninety-seven patients with American Society of Anaesthesiologists physical status II to III, scheduled to undergo elective lung resection surgery. Patients were randomly assigned to Group 40, 50, or 60. An autoflow ventilation mode with a lung protective ventilation strategy was applied to all patients. Respiratory rate was adjusted to maintain a partial pressure of arterial carbon dioxide of 40 ± 5 mmHg in Group 40, 50 ± 5 mmHg in Group 50 and 60 ± 5 mmHg in Group 60 during one-lung ventilation and at the end of surgery. The primary outcome was the arterial oxygen partial pressure/fractional inspired oxygen ratio after 60 min of one-lung ventilation. Data from 262 patients were analysed. The partial pressure/fractional inspired oxygen ratio was significantly higher in Group 50 and Group 60 than in Group 40 (269.4 vs. 262.9 vs. 214.4; P < 0.001) but was not significantly different between Group 50 and Group 60. The incidence of postoperative pulmonary complications was comparable among the three groups. Permissive hypercarbia improved lung oxygenation during one-lung ventilation without increasing the risk of postoperative pulmonary complications or the length of hospital stay. NCT04175379.

Effect of the VivaSight double-lumen tube on the incidence of hypoxaemia during one-lung ventilation in patients undergoing thoracoscopic surgery: a study protocol for a prospective randomised controlled trial

IntroductionA double-lumen tube (DLT) is a traditional one-lung ventilation tool that needs to be positioned under the guidance of a fibreoptic bronchoscope or auscultation. The placement is complex, and poor...

Effect of one-lung ventilation on the correlation between left and right cerebral saturation

BackgroundTo investigate if the correlation between left and right cerebral tissue oxygen saturation (SctO2) was affected by one-lung ventilation (OLV) in patients undergoing lung cancer surgery.MethodsPatients who underwent surgery for lung cancer were enrolled. Left and right SctO2 were collected during anesthesia. The primary outcome was the correlation between left and right SctO2 at 30 min after OLV which was analysed by Pearson correlation and linear regression model. Secondary outcomes included the trend of left–right SctO2 change over the first 30 min after OLV, correlation of left–right SctO2 during OLV for each patient; maximal difference between left–right SctO2 and its relationship with postoperative delirium.ResultsLeft–right SctO2 was moderately correlated at baseline (r = 0.690, P < 0.001) and poorly correlated at 30 min after OLV (r = 0.383, P < 0.001) in the Pearson correlation analysis. Linear regression analysis showed a poor correlation between left and right SctO2 at 30 min after OLV (r = 0.323, P < 0.001) after adjusting for confounders. The linear mixed model showed a change in left–right SctO2 over the first 30 min after OLV that was statistically significant (coefficient, -0.042; 95% CI, -0.070–-0.014; P = 0.004). For the left–right SctO2 correlation during OLV in each patient, 62.9% (78/124) patients showed a strong correlation, 19.4% (24/124) a medium correlation, and the rest a poor correlation. The maximal difference between the left and right SctO2 was 13.5 (9.0, 20.0). Multivariate analysis showed that it was not associated with delirium (odds ratio [OR], 1.023; 95% CI, 0.963–1.087; P = 0.463).ConclusionsThe correlation between left and right SctO2 was affected by one-lung ventilation in patients undergoing lung cancer surgery. This result indicates the requirement of bilateral SctO2 monitoring to reflect brain oxygenation.Trial registrationThis study was a secondary analysis of a cohort study approved by the Clinical Research Review Board of Peking University First Hospital (#2017–1378) and was registered in the Chinese Clinical Trial Registry on 10/09/2017 (http://www.chictr.org.cn, ChiCTR-ROC-17012627).

Effect of Driving Pressure-Oriented Ventilation on Patients Undergoing One-Lung Ventilation During Thoracic Surgery: A Systematic Review and Meta-Analysis.

BackgroundHypoxemia and fluctuations in respiratory mechanics parameters are common during one-lung ventilation (OLV) in thoracic surgery. Additionally, the incidence of postoperative pulmonary complications (PPCS) in thoracic surgery is higher than that in other surgeries. Previous studies have demonstrated that driving pressure-oriented ventilation can reduce both mortality in patients with acute respiratory distress syndrome (ARDS) and the incidence of PPCS in patients undergoing general anesthesia. Our aim was to determine whether driving pressure-oriented ventilation improves intraoperative physiology and outcomes in patients undergoing thoracic surgery.MethodsWe searched MEDLINE via PubMed, Embase, Cochrane, Web of Science, and ClinicalTrials.gov and performed a meta-analysis to compare the effects of driving pressure-oriented ventilation with other ventilation strategies on patients undergoing OLV. The primary outcome was the PaO2/FiO2 ratio (P/F ratio) during OLV. The secondary outcomes were the incidence of PPCS during follow-up, compliance of the respiratory system during OLV, and mean arterial pressure during OLV.ResultsThis review included seven studies, with a total of 640 patients. The PaO2/FiO2 ratio was higher during OLV in the driving pressure-oriented ventilation group (mean difference [MD]: 44.96; 95% confidence interval [CI], 24.22–65.70.32; I2: 58%; P < 0.0001). The incidence of PPCS was lower (OR: 0.58; 95% CI, 0.34–0.99; I2: 0%; P = 0.04) and the compliance of the respiratory system was higher (MD: 6.15; 95% CI, 3.97–8.32; I2: 57%; P < 0.00001) in the driving pressure-oriented group during OLV. We did not find a significant difference in the mean arterial pressure between the two groups.ConclusionDriving pressure-oriented ventilation during OLV in patients undergoing thoracic surgery was associated with better perioperative oxygenation, fewer PPCS, and improved compliance of the respiratory system.Systematic Review RegistrationPROSPERO, identifier: CRD42021297063.

Effects of Iloprost on Oxygenation during One-Lung Ventilation in Patients with Low Diffusing Capacity for Carbon Monoxide: A Randomized Controlled Study.

The protective mechanism of hypoxic pulmonary vasoconstriction during one-lung ventilation (OLV) is impaired in patients with a low diffusing capacity for carbon monoxide (DLCO). We hypothesized that iloprost inhalation would improve oxygenation and lung mechanics in patients with low DLCO who underwent pulmonary resection. Forty patients with a DLCO < 75% were enrolled. Patients were allocated into either an iloprost group (ILO group) or a control group (n = 20 each), in which iloprost and saline were inhaled, respectively. The partial pressure of arterial oxygen/fraction of inspired oxygen (PaO2/FiO2) ratio, pulmonary shunt fraction, alveolar dead space, dynamic compliance, and hemodynamic parameters were assessed 20 min after the initiation of OLV and 20 min after drug administration. Repeated variables were analyzed using a linear mixed model between the groups. Data from 39 patients were analyzed. After iloprost inhalation, the ILO group exhibited a significant increase in the PaO2/FiO2 ratio and a decrease in alveolar dead space compared with the control group (p = 0.025 and p = 0.042, respectively). Pulmonary shunt, dynamic compliance, hemodynamic parameters, and short-term prognosis were comparable between the two groups. Selective iloprost administration during OLV reduced alveolar dead space and improved oxygenation while minimally affecting hemodynamics and short-term prognosis.

Goal-directed fluid therapy versus restrictive fluid therapy: A cardiomerty study during one-lung ventilation in patients undergoing thoracic surgery

ABSTRACT Background Fluid management during thoracic anaesthesia is a challenge for the anaesthesiologists. The “safe zone” between volume overload (pulmonary oedema risk) and hypovolemia (renal failure risk) remains to be narrow and hard to determine. Purpose The aim of the present study was to assess goal-directed fluid therapy using cardiometry versus restrictive fluid therapy during one-lung ventilation in patients planned for having thoracic surgery. Methods After receiving the Ethics Committee approval and taking an informed written consent, a prospective randomized study was conducted. Fifty adult patients of both genders were scheduled for thoracic surgery with one lung ventilation. Patients were randomly categorized using closed envelope technique into two equal groups (25 patients each). Group I: a number of 25 patients underwent thoracic surgery and were managed with goal directed fluid therapy using intraoperative cardiometry. Group II: a number of 25 patients underwent thoracic surgery and were managed with intraoperative restrictive fluid therapy. Results There was a significantly increased serum lactate level, serum creatinine with decreased urine output in restrictive therapy group (RT) by the end of the surgery, immediately postoperative and 6 h postoperative (p value of <0.001). The restrictive hypoxic index values were much higher than the goal directed group values, yet, both were of normal range and no patient suffered of lung injury. A significant increase in serum neutrophil gelatinase-associated lipocalin (Ngal) in the restrictive therapy group compared to the goal directed therapy group. (p value of <0.001). Conclusion From these results, we concluded that patients undergoing thoracic surgery are preferably to be maintained over goal directed therapy protocol using electrical cardiometry. Fluid restriction is better to be individualized and aided by new technologies based on beat-to-beat variations.

Individualized positive end-expiratory pressure (PEEP) during one-lung ventilation for prevention of postoperative pulmonary complications in patients undergoing thoracic surgery: A meta-analysis.

Background:Positive end-expiratory pressure (PEEP) is an important part of the lung protection strategies for one-lung ventilation (OLV). However, a fixed PEEP value is not suitable for all patients. Our objective was to determine the prevention of individualized PEEP on postoperative complications in patients undergoing one-lung ventilation.Method:We searched the PubMed, Embase, and Cochrane and performed a meta-analysis to compare the effect of individual PEEP vs fixed PEEP during single lung ventilation on postoperative pulmonary complications. Our primary outcome was the occurrence of postoperative pulmonary complications during follow-up. Secondary outcomes included the partial pressure of arterial oxygen and oxygenation index during one-lung ventilation.Result:Eight studies examining 849 patients were included in this review. The rate of postoperative pulmonary complications was reduced in the individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37–0.73; P = .0001). The partial pressure of arterial oxygen during the OLV in the individualized PEEP group was higher with a mean difference 34.20 mm Hg (95% CI: 8.92–59.48; P = .0004). Similarly, the individualized PEEP group had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21–70.92; P < .0001).Conclusions:Individualized PEEP setting during one-lung ventilation in patients undergoing thoracic surgery was associated with fewer postoperative pulmonary complications and better perioperative oxygenation.

The Effects of Sevoflurane vs. Propofol for Inflammatory Responses in Patients Undergoing Lung Resection: A Meta-Analysis of Randomized Controlled Trials.

Objective: Inflammatory cytokines are increased during one-lung ventilation in patients undergoing lung resection, and this increase can be fatal. Propofol and sevoflurane are the main anesthetics used for these patients. Unfortunately, there is no consensus on the best choice of an anesthetic agent concerning an inflammatory response in patients undergoing lung resection. This meta-analysis aimed to compare the effects of propofol and sevoflurane on the inflammatory response in patients undergoing lung resection.Methods: We searched electronic databases to identify randomized controlled trials comparing the effects of different anesthetics (sevoflurane vs. propofol) on the inflammatory response. The primary outcome concerned the concentration of systemic inflammatory cytokines. The secondary outcomes concerned the concentrations of inflammatory cytokines in the bronchoalveolar lavage (BAL) fluid from the dependent and independent lung. Random effects analysis of the meta-analyses were performed to synthesize the evidence and to assess the concentrations of inflammatory factors in the sevoflurane and propofol groups.Results: Eight trials involving 488 participants undergoing lung resection with one-lung ventilation were included. There was no significant difference in the concentrations of systemic interleukin (IL)-6, IL-10, or tumor necrosis factor α between the sevoflurane and propofol groups. Compared with the propofol group, BAL levels of IL-6 in the dependent ventilated lung were decreased in the sevoflurane group (three trials, 256 participants; standardized mean difference [SMD], −0.51; 95% confidence interval [CI], −0.90 to −0.11; p = 0.01; I2 = 46%). The BAL levels of IL-6 in the independent ventilated lung were also decreased by sevoflurane (four trials, 362 participants; SMD, −0.70; 95% [CI], −0.93 to −0.47; p < 0.00001; I2 = 0%).Conclusions: There was no difference in the systemic inflammatory response between the sevoflurane and propofol groups. However, compared with propofol, sevoflurane can reduce the local alveolar inflammatory response. Additional research is necessary to confirm whether the inflammatory response is direct or indirect.

One Lung Ventilation in a Patient with Central Airway Obstruction: Fluoroscopic Guided Bronchial Blocker Placement

Thyroidectomy is the most common endocrine surgical treatment performed worldwide. Medullary thyroid carcinoma which accounts for less than 1.5 percent of these cases is different from other types of thyroid cancers in a way that it is a neuroendocrine malignancy that originates from the parafollicular C cells of the thyroid gland secreting calcitonin and it frequently spreads to lymph nodes and other organs. Anesthetic management in a case of a large thyroid mass with central airway obstruction is a task cut out for an anesthesiologist and the need to provide one-lung ventilation in these patients for thoracoscopic dissection of mediastinal lymph nodes adds to the challenges. In this case report, we describe fluoroscopic guided bronchial blocker placement as a novel technique for delivering one-lung ventilation in such patients, when the traditional approach of bronchial blocker placement with concomitant use of a fiber optic bronchoscope was not practicable due to the small size of the endotracheal tube in the presence of central airway obstruction.

Effect of electroacupuncture at Neiguan (PC 6) on pulmonary function during one-lung ventilation in patients with lobectomy

To observe the protective effect of electroacupuncture (EA) at Neiguan (PC 6) on pulmonary function during one-lung ventilation (OLV) in patients with lobectomy, and explore its action mechanism. Sixty patients with lobectomy were randomly divided into an observation group and a control group, 30 cases in each one. The patients in the control group were treated with general anesthesia, and OLV was given when surgery began; when the surgery finished, air was removed from the thoracic cavity and two-lung ventilation was performed. On the basis of the treatment in the control group, the patients in the observation group were treated with EA (disperse-dense wave, 2 Hz/100 Hz of frequency) at Neiguan (PC 6) 30 min before anesthesia induction until the end of the surgery. The pulmonary function indexes [arterial partial pressure of oxygen (PaO2), oxygenation index (OI), compliance of lung (CL), respiratory index (RI)] and serum levels of superoxide dismutase (SOD), malondialdehyde (MDA), interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were observed before surgery (T0), 30 min into OLV (T1), 60 min into OLV (T2) and after operation (T3). The total incidence of complications, pressing times of postoperative patient-controlled analgesia pump in 48 h after surgery and hospital stay were compared between the two groups. Compared with T0, the PaO2, OI, CL and serum SOD at T1, T2 and T3 in the two groups were decreased (P<0.05), and those in the observation group were higher than those in the control group (P<0.05). The RI and serum levels of MDA, IL-6, TNF-α at T1, T2 and T3 in the two groups were increased, and those in the observation group were lower than those in the control group (P<0.05). The total incidence of complications in the observation group was lower than that in the control group [3.3% (1/30) vs 23.3% (7/30), P<0.05]. The pressing times of postoperative patient-controlled analgesia pump in 48 h after surgery and hospital stay in the observation group were less than those in the control group (P<0.05). EA at Neiguan (PC 6) has protective effects on lung injury induced by OLV after lobectomy, and its mechanism may be related to the improvement of oxidative stress and inflammatory response.

One-lung ventilation in a patient with Fontan circulation undergoing diaphragmatic plication surgery: a case report

BackgroundSurgeries requiring one-lung ventilation (OLV) in patients with Fontan circulation pose great challenges. However, little information is available regarding the safety of OLV in Fontan patients when hemidiaphragmatic paralysis is present.Case presentationA 41-year-old woman who underwent repeated Fontan procedures was re-admitted to our hospital because of worsening shortness of breath. As left hemidiaphragmatic paralysis was considered to be contributing to her symptom, an open thoracic left diaphragmatic plication surgery was scheduled. A preoperative pulmonary artery angiogram revealed a remarkably reduced blood flow to the left lung. The surgeon requested OLV during the surgery. Despite our concern regarding the impact of OLV on the Fontan circulation, OLV did not result in major hemodynamic changes.ConclusionOLV can be safely implemented in patients with hemidiaphragmatic paralysis with preserved Fontan circulation. Preoperative pulmonary artery angiography may provide useful information for estimating the impact of OLV on the Fontan circulation.

The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial.

Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery, leading to perioperative complications. Inhaled iloprost is a selective pulmonary vasodilator with efficacy in patients with pulmonary hypertension. The purpose of this study was to evaluate the effects of off-label inhaled iloprost on oxygenation during OLV in patients undergoing lung surgery. Seventy-two patients who were scheduled for elective video-assisted thoracoscopic lobectomy were assigned to receive an inhaled nebulizer of distilled water (control group), 10 μg iloprost (IL10 group), or 20 μg iloprost (IL20 group). Arterial and venous blood gas and hemodynamic analyses were obtained. Changes in partial pressure of oxygen in arterial blood (PaO2), after the initiation of OLV and the resumption two-lung ventilation (TLV), were similar in all three groups. However, PaO2 in the IL10 group was comparable to that in the control group, whereas PaO2 in the IL20 group was significantly higher than that in the control group at 10, 20, and 30 min after administration of iloprost (275.1 ± 50.8 vs. 179.3 ± 38.9, p < 0.0001; 233.9 ± 39.7 vs. 155.1 ± 26.5, p < 0.0001; and 224.6 ± 36.4 vs. 144.0 ± 22.9, p < 0.0001, respectively). The shunt fraction in the IL20 group was significantly higher than that in the control group after administration of iloprost (26.8 ± 3.1 vs. 32.2 ± 3.4, p < 0.0001; 24.6 ± 2.2 vs. 29.9 ± 3.4, p < 0.0001; and 25.3 ± 2.0 vs. 30.8 ± 3.1, p < 0.0001, respectively). Administration of inhaled iloprost during OLV improves oxygenation and decreases intrapulmonary shunt.

Effects of penehyclidine hydrochloride combined with unilateral high-frequency jet ventilation on pulmonary function and inflammatory response during one-lung ventilation in patients with chronic obstructive pulmonary disease

Objective To evaluate the effects of penehyclidine hydrochloride (PHCD) combined with high-frequency jet ventilation (HFJV) of the operated lungs on pulmonary function and inflammatory response during one-lung ventilation (OLV) in patients with chronic obstructive pulmonary disease (COPD). Methods Sixty American Society of Anesthesiologists physical status Ⅱ or Ⅲ patients of both sexes with COPD, aged 40-64 yr, with body mass index of 17-26 kg/m2, scheduled for elective video-assisted thoracoscopic surgery under general anesthesia, were divided into 4 groups (n=15 each) using a random number table method: conventional group (group C), PHCD group (group P), HFJV group (group H) and PHCD combined with HFJV group (group PH). After induction of anesthesia, the patients were intubated with a double-lumen tube and then mechanically ventilated, with inspired oxygen concentration 100%, oxygen flow rate 2 L/min, tidal volume 6-8 ml/kg, respiratory rate 10-14 breaths/min, and respiratory rate was set at 12-16 breaths/min and PETCO2 was maintained at 40-45 mmHg during OLV.PHCD 0.01 mg/kg was intravenously injected before intubation in P and PH groups.The ventilation mode was changed to OLV after beginning of skin incision in each group.Ventilation of the lung on the operated side was performed by means of HFJV(driving pressure 0.5 kg/cm2)during OLV in P and PH groups.The pneumodynamic parameters such as airway peak pressure (Ppeak), airway plateau pressure (Pplat), airway resistance (Raw) and dynamic lung compliance (Cdyn) were monitored immediately before skin incision (T1) and at 60 and 120 min of OLV (T2, 3). Arterial blood samples were obtained at T2 for blood gas analysis, and oxygenation index (OI), respiratory index (RI), physiologic dead space fraction (VD/VT) and alveolar-arterial oxygen gradiant (A-aDO2) were calculated.Venous blood samples were drawn at T3 for determination of the serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and IL-8 by enzyme-linked immunosorbent assay.The occurrence of pulmonary complications was recorded within 72 h after operation. Results Compared with group C, the serum concentrations of TNF-α, IL-6 and IL-8, Ppeak, Pplat, Raw, RI, VD/VT, A-aDO2 and incidence of pulmonary complications were significantly decreased, and Cdyn and OI were increased in group P and group PH (P<0.05), and the serum concentrations of TNF-α, IL-6 and IL-8, RI, VD/VT, A-aDO2 and incidence of pulmonary complications were significantly decreased, and OI was increased in group H (P<0.05). Compared with group P or group H, the serum concentrations of TNF-α, IL-6 and IL-8, RI, VD/VT, A-aDO2 and incidence of pulmonary complications were significantly decreased, and OI was increased in group PH (P<0.05). Conclusion PHCD combined with HFJV of the operated lung produces better efficacy in improving respiratory function, inhibiting inflammatory responses, reducing lung injury and is more helpful in improving prognosis than either alone in the patients with COPD. Key words: Cholinergic antagonists; High-frequency jet ventilation; Pulmonary disease, chronic obstructive; Respiratory function tests; Systemic inflammatory response syndrome

The EZ-blocker for one-lung ventilation in patients undergoing thoracic surgery: clinical applications and experience in 100 cases in a routine clinical setting

BackgroundIn certain clinical situations the insertion of a double-lumen tube (DLT) for one-lung ventilation (OLV) is not feasible or unfavorable. In these cases, the EZ-Blocker (EZB) may serve as an alternative. The aim of our analysis was to report on the clinical applications and our experience with the EZB for one-lung ventilation in 100 patients undergoing thoracic surgery.MethodsAll anesthetic records from patients older than 18 years of age undergoing general anesthesia in the department of thoracic surgery with intraoperative use of an EZB for OLV at the University Hospital of Erlangen in four consecutive years were analyzed retrospectively.ResultsMost frequently, EZB was used in difficult airway (27%) and for surgical procedures with high risk for left recurrent laryngeal nerve injury (21%), followed by application in intubated (12%) or tracheostomized (11%) patients. 11% of the patients had an increased risk of gastric regurgitation. Almost all EZBs were placed free of complications (99%). Clinically sufficient lung collapse was achieved in all patients. No serious airway injuries or immediate complications were documented.ConclusionsThe EZB is an efficient, easy-to-use and safe airway device and enables OLV in several clinical situations, when conventional DLTs are not feasible or less favorable. Three major applications were depicted from the data: expected difficult airway, surgical procedures with necessity of intraoperative recurrent laryngeal nerve monitoring and already intubated or tracheostomized patients.