Yeungnam Univ J Med.  2018 Dec;35(2):165-170. 10.12701/yujm.2018.35.2.165.

Effects of small tidal volume and positive end-expiratory pressure on oxygenation in pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation

• Byun SH
• Lee SY
• Jung JY

• KMID: 2433734
• DOI: http://doi.org/10.12701/yujm.2018.35.2.165

Abstract

BACKGROUND
The purpose of this study was to investigate whether tidal volume (TV) of 8 mL/kg without positive end-expiratory pressure (PEEP) and TV of 6 mL/kg with or without PEEP in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode can maintain arterial oxygenation and decrease inspiratory airway pressure effectively during one-lung ventilation (OLV).
METHODS
The study enrolled 27 patients undergoing thoracic surgery. All patients were ventilated with PCV-VG mode. During OLV, patients were initially ventilated with TV 8 mL/kg (group TV8) without PEEP. Ventilation was subsequently changed to TV 6 mL/kg with PEEP (5 cmHâ‚‚O; group TV6+PEEP) or without (group TV6) in random sequence. Peak inspiratory pressure (P(peak)), mean airway pressure (P(mean)), and arterial blood gas analysis were measured 30 min after changing ventilator settings. Ventilation was then changed once more to add or eliminate PEEP (5 cmHâ‚‚O), while maintaining TV 6 mL/kg. Thirty min after changing ventilator settings, the same parameters were measured once more.
RESULTS
The P(peak) was significantly lower in group TV6 (19.3±.3 cmHâ‚‚O) than in group TV8 (21.8±3.1 cmHâ‚‚O) and group TV6+PEEP (20.1±3.4 cmHâ‚‚O). PaOâ‚‚ was significantly higher in group TV8 (242.5±111.4 mmHg) than in group TV6 (202.1±101.3 mmHg) (p=0.044). There was no significant difference in PaOâ‚‚ between group TV8 and group TV6+PEEP (226.8±121.1 mmHg). However, three patients in group TV6 were dropped from the study because PaOâ‚‚ was lower than 80 mmHg after ventilation.
CONCLUSION
It is postulated that TV 8 mL/kg without PEEP or TV 6 mL/kg with 5 cmHâ‚‚O PEEP in PCV-VG mode during OLV can safely maintain adequate oxygenation.

Keyword

Airway pressure; Arterial oxygenation; One-lung ventilation; Pressure-controlled ventilation-volume guaranteed

MeSH Terms

Blood Gas Analysis
Humans
One-Lung Ventilation*
Oxygen*
Positive-Pressure Respiration*
Thoracic Surgery
Tidal Volume*
Ventilation
Ventilators, Mechanical
Oxygen

Figure

• 

  Fig. 1. Consort diagram. TLV, supine two lung ventilation; TV, tidal volume; OLV, one-lung ventilation; Ppeak, peak inspiratory pressure; Pmean, mean inspiratory pressure; TVE, exhaled tidal volume; SpO2, peripheral oxygen saturation; EtCO2, end-tidal CO2; ABGA, arterial blood gas analysis; OLV, one-lung ventilation; PCV-VG, pressure-controlled ventilation-volume-guaranteed; PEEP, positive end expiratory pressure; PaO2, arterial oxygen pressure.

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