Yonsei Med J.  2015 Sep;56(5):1421-1427. 10.3349/ymj.2015.56.5.1421.

Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position

• Choi YS
• Bae MK
• Kim SH
• Park JE
• Kim SY
• Oh YJ

• KMID: 2163639
• DOI: http://doi.org/10.3349/ymj.2015.56.5.1421

Abstract

PURPOSE
Hypoxemia during one-lung ventilation (OLV) remains a serious problem, particularly in the supine position. We investigated the effects of alveolar recruitment (AR) and positive end-expiratory pressure (PEEP) on oxygenation during OLV in the supine position.
MATERIALS AND METHODS
Ninety-nine patients were randomly allocated to one of the following three groups: a control group (ventilation with a tidal volume of 8 mL/kg), a PEEP group (the same ventilatory pattern with a PEEP of 8 cm H2O), or an AR group (an AR maneuver immediately before OLV followed by a PEEP of 8 cm H2O). The tidal volume was reduced to 6 mL/kg during OLV in all groups. Blood gas analyses, respiratory variables, and hemodynamic variables were recorded 15 min into TLV (TLVbaseline), 15 and 30 min after OLV (OLV15 and OLV30), and 10 min after re-establishing TLV (TLVend).
RESULTS
Ultimately, 92 patients were analyzed. In the AR group, the arterial oxygen tension was higher at TLVend, and the physiologic dead space was lower at OLV15 and TLVend than in the control group. The mean airway pressure and dynamic lung compliance were higher in the PEEP and AR groups than in the control group at OLV15, OLV30, and TLVend. No significant differences in hemodynamic variables were found among the three groups throughout the study period.
CONCLUSION
Recruitment of both lungs with subsequent PEEP before OLV improved arterial oxygenation and ventilatory efficiency during video-assisted thoracic surgery requiring OLV in the supine position.

Keyword

Alveolar recruitment; one-lung ventilation; positive end-expiratory pressure; supine position

MeSH Terms

Adult
Aged
Anoxia
Female
Humans
Lung/physiopathology
Lung Compliance/physiology
Male
Middle Aged
One-Lung Ventilation/*methods
Oxygen/*blood
Positive-Pressure Respiration/*methods
Pulmonary Alveoli/*physiology
Pulmonary Gas Exchange
Respiratory Mechanics/*physiology
*Supine Position
Thoracic Surgery, Video-Assisted
Tidal Volume
Oxygen

Figure

• 

  Fig. 1 The consort flow diagram. PEEP, positive end-expiratory pressure.

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  Fig. 2 Changes in the PaCO2-ETCO2 difference (A) and estimated VD/VT (B). PaCO2-ETCO2, arterial to end-tidal carbon dioxide tension difference; estimated VD/VT, physiologic dead space. *p<0.05 vs. TLVbaseline in each group, †p<0.05 vs. control group.

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