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Effects of different tidal volumes for one-lung ventilation on oxygenation with open chest condition and surgical manipulation: a randomised cross-over trial.
MedLine Citation:
PMID:  23135690     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: The ideal tidal volume (VT) during one-lung ventilation (OLV) remains controversial. High tidal volumes may increase the incidence of postoperative lung injury after thoracic surgery. There is nonetheless little evidence that the use of low tidal volume during OLV will fail to provide adequate arterial oxygenation. We evaluated the influence of low (5 ml.kg-1) and high (10 ml.kg-1) tidal volume on arterial oxygenation during one-lung ventilation in clinical conditions. METHODS: 100 patients scheduled for lung surgery were studied. Patients were randomly assigned to either 30 minutes of one-lung ventilation with a tidal volume of 10 ml.kg-1 at a rate of 10 breaths/minute (Group 10, n=50) or a tidal volume of 5 ml.kg-1 with 5 cmH2O PEEP at a rate of 20 breaths/minute (Group 5, n=50). According to the rules of crossover design during the subsequent 30 minutes, each patient received the alternative management. Arterial blood partial pressures, hemodynamic responses, and ventilatory parameters were recorded. Results are presented as means ± SDs; P < 0.05 was considered statistically significant. RESULTS: PaO2 was unaffected by VT (10 ml.kg-1: 218±106 versus 5 ml.kg-1: 211±119 mmHg, p=0.29). Calculated intrapulmonary shunt fraction was also similar with each tidal volume during OLV (5 ml.kg-1: 25±9% versus 10 ml.kg-1: 24±8%, p=0.14). In contrast, low TV significantly increased PaCO2 (10 ml.kg-1: 39±6 versus 5 ml.kg-1: 44±8 mmHg, p<0.001). There were significant differences both in peak (10 ml.kg-1: 27±6 versus 5 ml.kg-1: 21±5 cmH2O, p<0.001) and plateau airway pressure values (10 ml.kg-1: 22±6 versus 5 ml.kg-1: 18±5 cmH2O, p<0.001) during OLV. CONCLUSIONS: Low tidal volume (5 ml.kg-1) accompanied by 5 cmH2O PEEP provides comparable arterial oxygenation and intrapulmonary shunt fraction during one-lung ventilation as higher tidal volume (10 ml.kg-1) without PEEP.
Authors:
T Vegh; M Juhasz; S Szatmari; A Enyedi; D I Sessler; L L Szegedi; B Fulesdi
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-08
Journal Detail:
Title:  Minerva anestesiologica     Volume:  -     ISSN:  1827-1596     ISO Abbreviation:  Minerva Anestesiol     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-8     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375272     Medline TA:  Minerva Anestesiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Anaesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary - ceghdr@gmail.com.
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