Differential lung ventilation for increased oxygenation during one lung ventilation for video assisted lung surgery.
Continuous positive airway pressure
Differential lung ventilation
One lung ventilation
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
06 May 2019
06 May 2019
Historique:
received:
06
02
2019
accepted:
22
04
2019
entrez:
8
5
2019
pubmed:
8
5
2019
medline:
2
7
2019
Statut:
epublish
Résumé
One lung ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the 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). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection. This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV + CPAP and OLV + DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage. Oxygenation during OLV+ CPAP was significantly lower that OLV + DLV (p = 0.018). There were insignificant alterations of pH, PCO2 and HCO3 during the different ventilating modes. The surgeons' assessments of interference in the field exposure between OLV + CPAP or OLV + DLV was found to be insignificant (p = 0.073). During OLV, DLV is superior to CPAP in improving patient's oxygenation, and may be used where CPAP failed. ClinicalTrials.gov NCT03563612 . Registered 9 June 2018, retrospectively (due to clerical error).
Sections du résumé
BACKGROUND
BACKGROUND
One lung ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the 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). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection.
PATIENTS AND METHOD
METHODS
This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV + CPAP and OLV + DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage.
RESULTS
RESULTS
Oxygenation during OLV+ CPAP was significantly lower that OLV + DLV (p = 0.018). There were insignificant alterations of pH, PCO2 and HCO3 during the different ventilating modes. The surgeons' assessments of interference in the field exposure between OLV + CPAP or OLV + DLV was found to be insignificant (p = 0.073).
CONCLUSIONS
CONCLUSIONS
During OLV, DLV is superior to CPAP in improving patient's oxygenation, and may be used where CPAP failed.
TRIAL REGISTRATION
BACKGROUND
ClinicalTrials.gov NCT03563612 . Registered 9 June 2018, retrospectively (due to clerical error).
Identifiants
pubmed: 31060627
doi: 10.1186/s13019-019-0910-2
pii: 10.1186/s13019-019-0910-2
pmc: PMC6503433
doi:
Substances chimiques
Oxygen
S88TT14065
Banques de données
ClinicalTrials.gov
['NCT03563612']
Types de publication
Clinical Trial
Comparative Study
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
89Références
Anesthesiol Clin North Am. 2001 Sep;19(3):475-95, vi
pubmed: 11571903
Crit Care. 2005;9(6):594-600
pubmed: 16356244
Interact Cardiovasc Thorac Surg. 2007 Apr;6(2):209-13
pubmed: 17669812
J Appl Physiol (1985). 2008 Jan;104(1):10-9
pubmed: 17947503
Anesthesiology. 2009 Jun;110(6):1402-11
pubmed: 19417615
BMC Res Notes. 2011 May 05;4:134
pubmed: 21545715
Anaesth Intensive Care. 2011 May;39(3):456-9
pubmed: 21675066
Eur Respir J. 2013 May;41(5):1179-88
pubmed: 22878884
J Cardiothorac Vasc Anesth. 2013 Jun;27(3):586-99
pubmed: 23672862
Ann Thorac Surg. 2013 Jul;96(1):127-32
pubmed: 23731612
Ann Cardiothorac Surg. 2013 Jul;2(4):408-18
pubmed: 23977616
Acta Anaesthesiol Scand. 2014 Apr;58(4):463-7
pubmed: 24588330
Crit Care Med. 2015 Oct;43(10):e404-11
pubmed: 26131598
Intensive Care Med Exp. 2015 Dec;3(1):56
pubmed: 26215820
J Appl Physiol (1985). 2017 Nov 1;123(5):1303-1320
pubmed: 28798196
J Thorac Dis. 2018 Mar;10(Suppl 4):S542-S554
pubmed: 29629201
Middle East J Anaesthesiol. 1988 Feb;9(4):357-62
pubmed: 3367882
Can J Anaesth. 1987 Sep;34(5):447-9
pubmed: 3664910
Anesth Analg. 1985 Aug;64(8):821-33
pubmed: 3893223
Ann Surg. 1985 Oct;202(4):425-39
pubmed: 3901940
Acta Anaesthesiol Scand. 1985 Oct;29(7):716-21
pubmed: 3907246
Acta Anaesthesiol Scand. 1995 Apr;39(3):307-11
pubmed: 7793206