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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
Minerva Anestesiologica 2013 January;79(1):24-32
Effects of different tidal volumes for one-lung ventilation on oxygenation with open chest condition and surgical manipulation: a randomised cross-over trial
Végh T. 1, 6, Juhász M. 1, Szatmári S. 1, Enyedi A. 2, Sessler D. I. 3, 4, 6, Szegedi L. L. 5, Fülesdi B. 1, 6 ✉
1 Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary;
2 Institute of Surgery, Division of Thoracic Surgery, University of Debrecen, Debrecen, Hungary;
3 Department of Outcomes Research, Cleveland Clinic, Cleveland, USA;
4 Population Health Research Institute, McMaster University, Hamilton, ON, Canada;
5 Department of Anesthesiology, Free University of Brussels, UZ Brussel, Belgium;
6 Outcomes Research Cosortium, Cleveland, OH, USA
Background: The ideal tidal volume (TV) during one-lung ventilation (OLV) remains controversial. High TVs may increase the incidence of postoperative lung injury after thoracic surgery. There is nonetheless little evidence that the use of low TV 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) TV on arterial oxygenation during one-lung ventilation in clinical conditions.
Methods: A hundred patients scheduled for lung surgery were studied. Patients were randomly assigned to either 30 minutes of one-lung ventilation with a TV of 10 mL/kg-1 at a rate of 10 breaths/minute (Group 10, N.=50) or a TV 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 TV (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 TV 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.
Conclusion: Low TV (5 mL/kg-1) accompanied by 5 cmH2O PEEP provides comparable arterial oxygenation and intrapulmonary shunt fraction during one-lung ventilation as higher TV (10 mL/kg-1) without PEEP.