| Physiological effects of a lung-recruiting strategy applied during one-lung ventilation. | |
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MedLine Citation:
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PMID: 18582305 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: One-lung ventilation (OLV) affects respiratory mechanics and ventilation/perfusion matching, reducing functional residual capacity of the ventilated lung. While the application of a lung-recruiting manoeuvre (RM) on the ventilated lung has been shown to improve oxygenation, data regarding the impact of RM on respiratory mechanics are not available. METHODS: Thirteen patients undergoing lung resection in lateral decubitus were studied. During OLV, a lung-recruiting strategy consisting in a RM lasting 1 min followed by the application of positive end-expiratory pressure 5 cmH(2)O was applied to the ventilated lung. Haemodynamics, gas exchange and respiratory mechanics parameters were recorded on two-lung ventilation (TLV(baseline)), OLV before and 20 min after the RM (OLV(pre-RM), OLV(post-RM), respectively) and TLV(end). Haemodynamics parameters were also recorded during the RM. RESULTS: The PaO(2)/FiO(2) ratio was 358+/-126 on TLV(baseline); it decreased to 235+/-113 on OLV(pre-RM) (P<0.01) increased to 351+/-120 on OLV(post-RM) (P<0.01 vs. OLV(pre-RM)), and remain stable thereafter. During the RM, CI decreased from 3.04+/-0.7 l/m(2) OLV(pre-RM) to 2.4+/-0.6 l/m(2) (P<0.05), and returned to baseline on OLV(post-RM) (3.1+/-0.7 l/m(2), NS vs. OLV(pre-RM)). The RM resulted in alveolar recruitment and caused a significant decrease in static elastance of the dependent lung (16.6+/-8.9 cmH(2)O/ml OLV(post-RM) vs. 22.3+/-8.1 cmH(2)O/ml OLV(pre-RM)) (P<0.01). CONCLUSIONS: During OLV in lateral decubitus for thoracic surgery, application to the dependent lung a recruiting strategy significantly recruits the dependent lung, improving arterial oxygenation and respiratory mechanics until the end of surgery. However, the transient haemodynamic derangement occurring during the RM should be taken into account. |
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Authors:
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G Cinnella; S Grasso; C Natale; F Sollitto; M Cacciapaglia; M Angiolillo; G Pavone; L Mirabella; M Dambrosio |
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Publication Detail:
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Type: Evaluation Studies; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Acta anaesthesiologica Scandinavica Volume: 52 ISSN: 1399-6576 ISO Abbreviation: Acta Anaesthesiol Scand Publication Date: 2008 Jul |
Date Detail:
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Created Date: 2008-06-27 Completed Date: 2008-10-28 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370270 Medline TA: Acta Anaesthesiol Scand Country: England |
Other Details:
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Languages: eng Pagination: 766-75 Citation Subset: IM |
Affiliation:
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Dipartimento di Scienze Chirurgiche, Sezione di Anestesiologia e Rianimazione, Università degli Studi di Foggia, Policlinico Riuniti, Foggia, Italy. g.cinnella@unifg.it |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Blood Gas Analysis / statistics & numerical data Clinical Protocols Female Hemodynamics / physiology* Humans Lung / physiology*, surgery Male Middle Aged Outcome and Process Assessment (Health Care) Pneumonectomy Posture / physiology* Respiration, Artificial / methods* Respiratory Function Tests / statistics & numerical data |
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