Korean J Anesthesiol.  2014 Aug;67(2):96-102. 10.4097/kjae.2014.67.2.96.

Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test

• Jung JD
• Kim SH
• Yu BS
• Kim HJ

• KMID: 2227410
• DOI: http://doi.org/10.4097/kjae.2014.67.2.96

Abstract

BACKGROUND
Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP).
METHODS
In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began.
RESULTS
Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05).
CONCLUSIONS
Preemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

Keyword

Alveolar recruitment; One-lung ventilation; Oxygenation; PEEP; Preemptive; Tidal volume

MeSH Terms

Anoxia
Humans
Lung Injury
One-Lung Ventilation*
Oxygen*
Positive-Pressure Respiration
Respiratory Function Tests*
Thoracostomy
Tidal Volume*
Ventilation
Oxygen