Document Detail


Gravity is an important determinant of oxygenation during one-lung ventilation.
MedLine Citation:
PMID:  20397977     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The role of gravity in the redistribution of pulmonary blood flow during one-lung ventilation (OLV) has been questioned recently. To address this controversial but clinically important issue, we used an experimental approach that allowed us to differentiate the effects of gravity from the effects of hypoxic pulmonary vasoconstriction (HPV) on arterial oxygenation during OLV in patients scheduled for thoracic surgery. METHODS: Forty patients with chronic obstructive pulmonary disease scheduled for right lung tumour resection were randomized to undergo dependent (left) one-lung ventilation (D-OLV; n=20) or non-dependent (right) one-lung ventilation (ND-OLV; n=20) in the supine and left lateral positions. Partial pressure of arterial oxygen (PaO2) was measured as a surrogate for ventilation/perfusion matching. Patients were studied before surgery under closed chest conditions. RESULTS: When compared with bilateral lung ventilation, both D-OLV and ND-OLV caused a significant and equal decrease in PaO(2) in the supine position. However, D-OLV in the lateral position was associated with a higher PaO2 as compared with the supine position [274.2 (77.6) vs. 181.9 (68.3) mmHg, P<0.01, analysis of variance (ANOVA)]. In contrast, in patients undergoing ND-OLV, PaO2 was always lower in the lateral as compared with the supine position [105.3 (63.2) vs. 187 (63.1) mmHg, P<0.01, ANOVA]. CONCLUSION: The relative position of the ventilated vs. the non-ventilated lung markedly affects arterial oxygenation during OLV. These data suggest that gravity affects ventilation-perfusion matching independent of HPV.
Authors:
L L Szegedi; A A D'Hollander; F E Vermassen; F Deryck; P F Wouters
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2010-04-14
Journal Detail:
Title:  Acta anaesthesiologica Scandinavica     Volume:  54     ISSN:  1399-6576     ISO Abbreviation:  Acta Anaesthesiol Scand     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-10-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370270     Medline TA:  Acta Anaesthesiol Scand     Country:  England    
Other Details:
Languages:  eng     Pagination:  744-50     Citation Subset:  IM    
Affiliation:
Department of Anaesthesiology, Ghent University Hospital, Ghent, Belgium. laszlo.szegedi@ugent.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Female
Gravitation*
Humans
Intraoperative Care
Lung / physiopathology
Lung Neoplasms / surgery
Male
Middle Aged
Monitoring, Intraoperative
Oxygen / blood*
Partial Pressure
Patient Positioning*
Pneumonectomy
Posture / physiology*
Pulmonary Circulation
Pulmonary Disease, Chronic Obstructive / physiopathology*
Pulmonary Ventilation
Respiration, Artificial / methods*
Respiratory Function Tests
Supine Position / physiology
Surgical Procedures, Elective
Chemical
Reg. No./Substance:
7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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