Document Detail


Intrinsic positive end-expiratory pressure during one-lung ventilation for thoracic surgery. The influence of preoperative pulmonary function.
MedLine Citation:
PMID:  8681625     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To detect and to quantify intrinsic positive end-expiratory pressure (PEEPi) during thoracic surgery in the dependent lung of patients intubated with a double-lumen endotracheal tube (DLT) in the lateral position. METHODS: Twenty consecutive patients undergoing elective pulmonary resection were anesthetized, paralyzed, and intubated with a DLT. Their lungs were ventilated (Siemens Servo 900 C ventilator; Siemens Elevna; Solna, Sweden) with constant inspiratory flow. Fraction of inspired oxygen, tidal volume (10 mL/kg), frequency (10/min), and inspiratory time/total time (0.33) were kept constant during the study. PEEPi and ventilatory data were measured in the dependent lung in the supine then in the lateral position with a closed hemithorax. The obtained data were analyzed according to the presence (group PH) or absence (group N) of pulmonary hyperinflation determined from the preoperative pulmonary function data as higher than 120% of predicted value of functional residual capacity (FRC) and residual volume (RV). DATA ANALYSIS: In the dependent lung of patients in group PH (n = 11), PEEPi was present in the supine (n = 8) and in the lateral (n = 11) positions in the range of 1 to 10 cm H2O. In group N (n = 9), PEEPi was detected in one patient and only in the supine position. In the whole group of 20 patients, the preoperative value of FRC (% predicted) and RV (% predicted) was statistically significantly correlated to the presence of PEEPi, whereas the preoperative FEV1 (% predicted) was poorly related to PEEPi in both positions. There was no significant correlation between the value of PaCO2 and PEEPi during one-lung ventilation (OLV) but patients in group PH had a significantly higher PaCO2 during OLV than group N (p = 0.012). CONCLUSIONS: In patients with chronic obstructive lung disease and pulmonary hyperinflation, PEEPi occurs commonly during the period of OLV and only occasionally in patients with normal lungs. As the ventilatory pattern, the size of DLT, and the side of surgery were similar in the two groups of patients, we conclude that the occurrence of PEEPi in our patients was influenced mainly by the preexisting pulmonary hyperinflation and airflow obstruction.
Authors:
G I Bardoczky; J C Yernault; E E Engelman; C E Velghe; M Cappello; A A Hollander
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  110     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1996 Jul 
Date Detail:
Created Date:  1996-08-21     Completed Date:  1996-08-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  180-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Erasme University Hospital, Free University of Brussels, Belgium.
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MeSH Terms
Descriptor/Qualifier:
Forced Expiratory Volume
Functional Residual Capacity
Humans
Intraoperative Complications / diagnosis*
Intubation, Intratracheal
Lung / surgery*
Middle Aged
Positive-Pressure Respiration, Intrinsic / diagnosis*
Residual Volume
Respiration, Artificial*
Respiratory Mechanics*
Comments/Corrections
Erratum In:
Chest 1997 Mar;111(3):836

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


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