1
|
Peng J, Guo G, Wang Z, Zhuang L, Ma Y, Yuan B, Zhang M, Tao Q, Zhao Y, Zhao L, Dong X. Factors Associated With Radiological Lung Growth Rate After Lobectomy in Patients With Lung Cancer. J Surg Res 2024; 298:251-259. [PMID: 38636181 DOI: 10.1016/j.jss.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/21/2024] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
INTRODUCTION This study is a retrospective study. This study aims to explore the association between lobectomy in lung cancer patients and subsequent compensatory lung growth (CLG), and to identify factors that may be associated with variations in CLG. METHODS 207 lung cancer patients who underwent lobectomy at Yunnan Cancer Hospital between January 2020 and December 2020. All patients had stage IA primary lung cancer and were performed by the same surgical team. And computed tomography examinations were performed before and 1 y postoperatively. Based on computed tomography images, the volume of each lung lobe was measured using computer software and manual, the radiological lung weight was calculated. And multiple linear regressions were used to analyze the factors related to the increase in postoperative lung weight. RESULTS One year after lobectomy, the radiological lung weight increased by an average of 112.4 ± 20.8%. Smoking history, number of resected lung segments, preoperative low attenuation volume, intraoperative arterial oxygen partial pressure/fraction of inspired oxygen ratio and postoperative visual analog scale scores at 48 h were significantly associated with postoperative radiological lung weight gain. CONCLUSIONS Our results suggest that CLG have occurred after lobectomy in adults. In addition, anesthetists should maintain high arterial oxygen partial pressure/fraction of inspired oxygen ratio during one-lung ventilation and improve acute postoperative pain to benefit CLG.
Collapse
Affiliation(s)
- Jing Peng
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Gang Guo
- Department of Thoracic Surgery II, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunman, China
| | - Zhonghui Wang
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Li Zhuang
- Department of Palliative Medicine, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Yuhui Ma
- Department of Thoracic Surgery I, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Bin Yuan
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Mingxiong Zhang
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Qunfen Tao
- Department of Operation Room, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China
| | - Yanqiu Zhao
- Department of Thoracic Surgery II, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunman, China
| | - Li Zhao
- Department of Anesthesiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China.
| | - Xingxiang Dong
- Department of Radiology, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming, Yunnan, China.
| |
Collapse
|
2
|
Niroomand A, Qvarnström S, Stenlo M, Malmsjö M, Ingemansson R, Hyllén S, Lindstedt S. The role of mechanical ventilation in primary graft dysfunction in the postoperative lung transplant recipient: A single center study and literature review. Acta Anaesthesiol Scand 2022; 66:483-496. [PMID: 35014027 PMCID: PMC9303877 DOI: 10.1111/aas.14025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/10/2021] [Accepted: 12/22/2021] [Indexed: 12/11/2022]
Abstract
Background Primary graft dysfunction (PGD) is still a major complication in patients undergoing lung transplantation (LTx). Much is unknown about the effect of postoperative mechanical ventilation on outcomes, with debate on the best approach to ventilation. Aim/Purpose The goal of this study was to generate hypotheses on the association between postoperative mechanical ventilation settings and allograft size matching in PGD development. Method This is a retrospective study of LTx patients between September 2011 and September 2018 (n = 116). PGD was assessed according to the International Society of Heart and Lung Transplantation (ISHLT) criteria. Data were collected from medical records, including chest x‐ray assessments, blood gas analysis, mechanical ventilator parameters and spirometry. Results Positive end‐expiratory pressures (PEEP) of 5 cm H2O were correlated with lower rates of grade 3 PGD. Graft size was important as tidal volumes calculated according to the recipient yielded greater rates of PGD when low volumes were used, a correlation that was lost when donor metrics were used. Conclusion Our results highlight a need for greater investigation of the role donor characteristics play in determining post‐operative ventilation of a lung transplant recipient. The mechanical ventilation settings on postoperative LTx recipients may have an implication for the development of acute graft dysfunction. Severe PGD was associated with the use of a PEEP higher than 5 and lower tidal volumes and oversized lungs were associated with lower long‐term mortality. Lack of association between ventilatory settings and survival may point to the importance of other variables than ventilation in the development of PGD.
Collapse
Affiliation(s)
- Anna Niroomand
- Department of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery and Transplantation Skåne University Hospital Lund University Lund Sweden
- Wallenberg Center for Molecular Medicine Lund University Lund Sweden
- Lund Stem Cell Center Lund University Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
- Rutgers Robert University New Brunswick New Jersey USA
| | - Sara Qvarnström
- Department of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery and Transplantation Skåne University Hospital Lund University Lund Sweden
| | - Martin Stenlo
- Department of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery and Transplantation Skåne University Hospital Lund University Lund Sweden
- Lund Stem Cell Center Lund University Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences Lund University Lund Sweden
| | - Richard Ingemansson
- Department of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery and Transplantation Skåne University Hospital Lund University Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Snejana Hyllén
- Department of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery and Transplantation Skåne University Hospital Lund University Lund Sweden
- Lund Stem Cell Center Lund University Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| | - Sandra Lindstedt
- Department of Cardiothoracic Anesthesia and Intensive Care and Cardiothoracic Surgery and Transplantation Skåne University Hospital Lund University Lund Sweden
- Wallenberg Center for Molecular Medicine Lund University Lund Sweden
- Lund Stem Cell Center Lund University Lund Sweden
- Department of Clinical Sciences Lund University Lund Sweden
| |
Collapse
|
3
|
Sayed El Hefny DAE, Mohamed MI, Yousef El-Metainy SA, Ibrahim Abdelaal MM, Osman YM. Effect of Stepwise Lung Recruitment Maneuver on Oxygenation, Lung Mechanics and Lung Injury Biomarkers During Lung Resection Surgery: A Prospective Randomized Controlled Single Blinded Study. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.2020987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
| | | | | | | | - Yasser Mohamed Osman
- Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| |
Collapse
|
4
|
Li P, Kang X, Miao M, Zhang J. Individualized positive end-expiratory pressure (PEEP) during one-lung ventilation for prevention of postoperative pulmonary complications in patients undergoing thoracic surgery: A meta-analysis. Medicine (Baltimore) 2021; 100:e26638. [PMID: 34260559 PMCID: PMC8284741 DOI: 10.1097/md.0000000000026638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/24/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Positive end-expiratory pressure (PEEP) is an important part of the lung protection strategies for one-lung ventilation (OLV). However, a fixed PEEP value is not suitable for all patients. Our objective was to determine the prevention of individualized PEEP on postoperative complications in patients undergoing one-lung ventilation. METHOD We searched the PubMed, Embase, and Cochrane and performed a meta-analysis to compare the effect of individual PEEP vs fixed PEEP during single lung ventilation on postoperative pulmonary complications. Our primary outcome was the occurrence of postoperative pulmonary complications during follow-up. Secondary outcomes included the partial pressure of arterial oxygen and oxygenation index during one-lung ventilation. RESULT Eight studies examining 849 patients were included in this review. The rate of postoperative pulmonary complications was reduced in the individualized PEEP group with a risk ratio of 0.52 (95% CI:0.37-0.73; P = .0001). The partial pressure of arterial oxygen during the OLV in the individualized PEEP group was higher with a mean difference 34.20 mm Hg (95% CI: 8.92-59.48; P = .0004). Similarly, the individualized PEEP group had a higher oxygenation index, MD: 49.07mmHg, (95% CI: 27.21-70.92; P < .0001). CONCLUSIONS Individualized PEEP setting during one-lung ventilation in patients undergoing thoracic surgery was associated with fewer postoperative pulmonary complications and better perioperative oxygenation.
Collapse
|
5
|
Tidal volume during 1-lung ventilation: A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2020; 163:1573-1585.e1. [PMID: 33518385 DOI: 10.1016/j.jtcvs.2020.12.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND The selection of tidal volumes for 1-lung ventilation remains unclear, because there exists a trade-off between oxygenation and risk of lung injury. We conducted a systematic review and meta-analysis to determine how oxygenation, compliance, and clinical outcomes are affected by tidal volume during 1-lung ventilation. METHODS A systematic search of MEDLINE and EMBASE was performed. A systematic review and random-effects meta-analysis was conducted. Pooled mean difference estimated arterial oxygen tension, compliance, and length of stay; pooled odds ratio was calculated for composite postoperative pulmonary complications. Risk of bias was determined using the Cochrane risk of bias and Newcastle-Ottawa tools. RESULTS Eighteen studies were identified, comprising 3693 total patients. Low tidal volumes (5.6 [±0.9] mL/kg) were not associated with significant differences in partial pressure of oxygen (-15.64 [-88.53-57.26] mm Hg; P = .67), arterial oxygen tension to fractional intake of oxygen ratio (14.71 [-7.83-37.24]; P = .20), or compliance (2.03 [-5.22-9.27] mL/cmH2O; P = .58) versus conventional tidal volume ventilation (8.1 [±3.1] mL/kg). Low versus conventional tidal volume ventilation had no significant impact on hospital length of stay (-0.42 [-1.60-0.77] days; P = .49). Low tidal volumes are associated with significantly decreased odds of pulmonary complications (pooled odds ratio, 0.40 [0.29-0.57]; P < .0001). CONCLUSIONS Low tidal volumes during 1-lung ventilation do not worsen oxygenation or compliance. A low tidal volume ventilation strategy during 1-lung ventilation was associated with a significant reduction in postoperative pulmonary complications.
Collapse
|
6
|
Physiologic Evaluation of Ventilation Perfusion Mismatch and Respiratory Mechanics at Different Positive End-expiratory Pressure in Patients Undergoing Protective One-lung Ventilation. Anesthesiology 2019; 128:531-538. [PMID: 29215365 DOI: 10.1097/aln.0000000000002011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Arterial oxygenation is often impaired during one-lung ventilation, due to both pulmonary shunt and atelectasis. The use of low tidal volume (VT) (5 ml/kg predicted body weight) in the context of a lung-protective approach exacerbates atelectasis. This study sought to determine the combined physiologic effects of positive end-expiratory pressure and low VT during one-lung ventilation. METHODS Data from 41 patients studied during general anesthesia for thoracic surgery were collected and analyzed. Shunt fraction, high V/Q and respiratory mechanics were measured at positive end-expiratory pressure 0 cm H2O during bilateral lung ventilation and one-lung ventilation and, subsequently, during one-lung ventilation at 5 or 10 cm H2O of positive end-expiratory pressure. Shunt fraction and high V/Q were measured using variation of inspired oxygen fraction and measurement of respiratory gas concentration and arterial blood gas. The level of positive end-expiratory pressure was applied in random order and maintained for 15 min before measurements. RESULTS During one-lung ventilation, increasing positive end-expiratory pressure from 0 cm H2O to 5 cm H2O and 10 cm H2O resulted in a shunt fraction decrease of 5% (0 to 11) and 11% (5 to 16), respectively (P < 0.001). The PaO2/FIO2 ratio increased significantly only at a positive end-expiratory pressure of 10 cm H2O (P < 0.001). Driving pressure decreased from 16 ± 3 cm H2O at a positive end-expiratory pressure of 0 cm H2O to 12 ± 3 cm H2O at a positive end-expiratory pressure of 10 cm H2O (P < 0.001). The high V/Q ratio did not change. CONCLUSIONS During low VT one-lung ventilation, high positive end-expiratory pressure levels improve pulmonary function without increasing high V/Q and reduce driving pressure.
Collapse
|
7
|
Effects of Positive End-Expiratory Pressure on Pulmonary Oxygenation and Biventricular Function during One-Lung Ventilation: A Randomized Crossover Study. J Clin Med 2019; 8:jcm8050740. [PMID: 31126111 PMCID: PMC6571862 DOI: 10.3390/jcm8050740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 12/05/2022] Open
Abstract
Although the application of positive end-expiratory pressure (PEEP) can alter cardiopulmonary physiology during one-lung ventilation (OLV), these changes have not been clearly elucidated. This study assessed the effects of different levels of PEEP on biventricular function, as well as pulmonary oxygenation during OLV. Thirty-six lung cancer patients received one PEEP combination of six sequences, consisting of 0 (PEEP_0), 5 (PEEP_5), and 10 cmH2O (PEEP_10), using a crossover design during OLV. The ratio of arterial oxygen partial pressure to inspired oxygen fraction (P/F ratio), systolic and diastolic echocardiographic parameters were measured at 20 min after the first, second, and third PEEP. P/F ratio at PEEP_5 was significantly higher compared to PEEP_0 (p = 0.014), whereas the P/F ratio at PEEP_10 did not show significant differences compared to PEEP_0 or PEEP_5. Left ventricular ejection fraction (LV EF) and right ventricular fractional area change (RV FAC) at PEEP_10 (EF, p < 0.001; FAC, p = 0.001) were significantly lower compared to PEEP_0 or PEEP_5. RV E/E’ (p = 0.048) and RV myocardial performance index (p < 0.001) at PEEP_10 were significantly higher than those at PEEP_0 or PEEP_5. In conclusion, increasing PEEP to 10 cmH2O decreased biventricular function, especially on RV function, with no further improvement on oxygenation compared to PEEP 5 cmH2O during OLV.
Collapse
|
8
|
Reinius H, Borges JB, Engström J, Ahlgren O, Lennmyr F, Larsson A, Fredén F. Optimal PEEP during one-lung ventilation with capnothorax: An experimental study. Acta Anaesthesiol Scand 2019; 63:222-231. [PMID: 30132806 DOI: 10.1111/aas.13247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 07/12/2018] [Accepted: 07/24/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND One-lung ventilation (OLV) with induced capnothorax carries the risk of severely impaired ventilation and circulation. Optimal PEEP may mitigate the physiological perturbations during these conditions. METHODS Right-sided OLV with capnothorax (16 cm H2 O) on the left side was initiated in eight anesthetized, muscle-relaxed piglets. A recruitment maneuver and a decremental PEEP titration from PEEP 20 cm H2 O to zero end-expiratory pressure (ZEEP) was performed. Regional ventilation and perfusion were studied with electrical impedance tomography and computer tomography of the chest was used. End-expiratory lung volume and hemodynamics were recorded and. RESULTS PaO2 peaked at PEEP 12 cm H2 O (49 ± 14 kPa) and decreased to 11 ± 5 kPa at ZEEP (P < 0.001). PaCO2 was 9.5 ± 1.3 kPa at 20 cm H2 O PEEP and did not change when PEEP step-wise was reduced to 12 cm H2 O PaCO2. At lower PEEP, PaCO2 increased markedly. The ventilatory driving pressure was lowest at PEEP 14 cm H2 O (19.6 ± 5.8 cm H2 O) and increased to 38.3 ± 6.1 cm H2 O at ZEEP (P < 0.001). When reducing PEEP below 12-14 cm H2 O ventilation shifted from the dependent to the nondependent regions of the ventilated lung (P = 0.003), and perfusion shifted from the ventilated to the nonventilated lung (P = 0.02). CONCLUSION Optimal PEEP was 12-18 cm H2 O and probably relates to capnothorax insufflation pressure. With suboptimal PEEP, ventilation/perfusion mismatch in the ventilated lung and redistribution of blood flow to the nonventilated lung occurred.
Collapse
Affiliation(s)
- Henrik Reinius
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - Joao Batista Borges
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
- Laboratório de Pneumologia LIM-09; Disciplina de Pneumologia; Heart Institute (Incor) Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; São Paulo Brazil
| | - Joakim Engström
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - Oskar Ahlgren
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - Fredrik Lennmyr
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
- Department of Cardiothoracic Anesthesia; Uppsala University Hospital; Uppsala Sweden
| | - Anders Larsson
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| | - Filip Fredén
- Department of Surgical Sciences; Hedenstierna laboratory; Section of Anesthesiology and Intensive Care; Uppsala University; Uppsala Sweden
| |
Collapse
|
9
|
El Tahan MR, Pasin L, Marczin N, Landoni G. Impact of Low Tidal Volumes During One-Lung Ventilation. A Meta-Analysis of Randomized Controlled Trials. J Cardiothorac Vasc Anesth 2017; 31:1767-1773. [DOI: 10.1053/j.jvca.2017.06.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Indexed: 12/18/2022]
|
10
|
Verbeek GL, Myles PS, Westall GP, Lin E, Hastings SL, Marasco SF, Jaffar J, Meehan AC. Intra-operative protective mechanical ventilation in lung transplantation: a randomised, controlled trial. Anaesthesia 2017; 72:993-1004. [DOI: 10.1111/anae.13964] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 12/19/2022]
Affiliation(s)
- G. L. Verbeek
- Department of Anaesthesia and Peri-operative Medicine; The Alfred Hospital; Melbourne Australia
| | - P. S. Myles
- Department of Anaesthesia and Peri-operative Medicine; The Alfred Hospital; Melbourne Australia
| | - G. P. Westall
- Cardiothoracic Unit; The Alfred Hospital; Melbourne Australia
| | - E. Lin
- Cardiothoracic Unit; The Alfred Hospital; Melbourne Australia
| | - S. L. Hastings
- Cardiothoracic Unit; The Alfred Hospital; Melbourne Australia
| | - S. F. Marasco
- Cardiothoracic Unit; The Alfred Hospital; Melbourne Australia
| | - J. Jaffar
- Department of Immunology; Monash University; Melbourne Australia
| | - A. C. Meehan
- Department of Immunology; Monash University; Melbourne Australia
| |
Collapse
|
11
|
Liu J, Liao X, Li Y, Luo H, Huang W, Peng L, Fang Q, Hu Z. Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation. Anaesthesist 2017; 66:667-671. [PMID: 28656353 DOI: 10.1007/s00101-017-0330-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 05/13/2017] [Accepted: 05/25/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND An increasing number of studies have shown that low tidal volume (TV) with positive end-expiratory pressure (PEEP) offers lung protection during one-lung ventilation (OLV). Considering the unique physiological characteristics of infants, we aimed to determine the feasibility and effect of low TV with PEEP in infants undergoing OLV during thoracoscopy. PATIENTS AND METHODS We randomized 60 infants to a conventional group (group I: TV, 8-10 ml/kg; RR, 23-45 bpm; PEEP, 0 cmH2O) or a low TV with PEEP group (group II: TV, 5-7 ml/kg; RR, 23-45 bpm; PEEP, 4-6 cmH2O). Arterial blood gas analyses were performed at four time points: 5 min of two-lung ventilation (TLV, T0), and 20 min, 40 min, and 60 min of OLV (T1, T2, T3); hemodynamic parameters (heart rate, mean blood pressure), temperature, as well as gas exchange (SpO2 and PETCO2) and ventilation parameters (FiO2, PEEP, Pmax) were recorded simultaneously. Lung compliance and shunt were also calculated. RESULT No significant difference was found between both groups at T0. Compared with T0, PETCO2, Pmax, PaCO2, lactic acid, and intrapulmonary shunt volume (Qs/Qt) were increased while PaO2 and respiratory system compliance (Cdyx) were decreased noticeably in both groups at T1, T2, and T3. At T1, T2, and T3, Pmax and Qs/Qt were much lower while PETCO2, PaCO2, and Cdyx were higher in group II than in group I. There was no significant difference in lactic acid and PaO2 measurements between the two groups at T1, T2, and T3. CONCLUSION Low TV with PEEP could be an effective intraoperative ventilation strategy for infants undergoing OLV during video-assisted thoracoscopic surgery and may reduce the risk of lung injury. However, this strategy, as well as the influence of intraoperative hypercapnia on infants, needs further investigation.
Collapse
Affiliation(s)
- Jing Liu
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Xinfang Liao
- FoShan City Nanhai District People's Hospital, 528200, Foshan, China
| | - Yongle Li
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Hui Luo
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Weijian Huang
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Lingli Peng
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Qin Fang
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China
| | - Zurong Hu
- Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China.
- , No. 521, Xingnandadao, Panyu District, Guangzhou, Guangdong, China.
| |
Collapse
|
12
|
Soluri-Martins A, Moraes L, Santos RS, Santos CL, Huhle R, Capelozzi VL, Pelosi P, Silva PL, de Abreu MG, Rocco PRM. Variable Ventilation Improved Respiratory System Mechanics and Ameliorated Pulmonary Damage in a Rat Model of Lung Ischemia-Reperfusion. Front Physiol 2017; 8:257. [PMID: 28512431 PMCID: PMC5411427 DOI: 10.3389/fphys.2017.00257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/10/2017] [Indexed: 12/28/2022] Open
Abstract
Lung ischemia-reperfusion injury remains a major complication after lung transplantation. Variable ventilation (VV) has been shown to improve respiratory function and reduce pulmonary histological damage compared to protective volume-controlled ventilation (VCV) in different models of lung injury induced by endotoxin, surfactant depletion by saline lavage, and hydrochloric acid. However, no study has compared the biological impact of VV vs. VCV in lung ischemia-reperfusion injury, which has a complex pathophysiology different from that of other experimental models. Thirty-six animals were randomly assigned to one of two groups: (1) ischemia-reperfusion (IR), in which the left pulmonary hilum was completely occluded and released after 30 min; and (2) Sham, in which animals underwent the same surgical manipulation but without hilar clamping. Immediately after surgery, the left (IR-injured) and right (contralateral) lungs from 6 animals per group were removed, and served as non-ventilated group (NV) for molecular biology analysis. IR and Sham groups were further randomized to one of two ventilation strategies: VCV (n = 6/group) [tidal volume (VT) = 6 mL/kg, positive end-expiratory pressure (PEEP) = 2 cmH2O, fraction of inspired oxygen (FiO2) = 0.4]; or VV, which was applied on a breath-to-breath basis as a sequence of randomly generated VT values (n = 1200; mean VT = 6 mL/kg), with a 30% coefficient of variation. After 5 min of ventilation and at the end of a 2-h period (Final), respiratory system mechanics and arterial blood gases were measured. At Final, lungs were removed for histological and molecular biology analyses. Respiratory system elastance and alveolar collapse were lower in VCV than VV (mean ± SD, VCV 3.6 ± 1.3 cmH20/ml and 2.0 ± 0.8 cmH20/ml, p = 0.005; median [interquartile range], VCV 20.4% [7.9–33.1] and VV 5.4% [3.1–8.8], p = 0.04, respectively). In left lungs of IR animals, VCV increased the expression of interleukin-6 and intercellular adhesion molecule-1 compared to NV, with no significant differences between VV and NV. Compared to VCV, VV increased the expression of surfactant protein-D, suggesting protection from type II epithelial cell damage. In conclusion, in this experimental lung ischemia-reperfusion model, VV improved respiratory system elastance and reduced lung damage compared to VCV.
Collapse
Affiliation(s)
- André Soluri-Martins
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Lillian Moraes
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Raquel S Santos
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Cintia L Santos
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Robert Huhle
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Dresden University of TechnologyDresden, Germany
| | - Vera L Capelozzi
- Department of Pathology, School of Medicine, University of São PauloSão Paulo, Brazil
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of GenoaGenoa, Italy
| | - Pedro L Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| | - Marcelo Gama de Abreu
- Pulmonary Engineering Group, Department of Anesthesiology and Intensive Care Therapy, University Hospital Carl Gustav Carus, Dresden University of TechnologyDresden, Germany
| | - Patricia R M Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de JaneiroRio de Janeiro, Brazil
| |
Collapse
|
13
|
How to minimise ventilator-induced lung injury in transplanted lungs: The role of protective ventilation and other strategies. Eur J Anaesthesiol 2016; 32:828-36. [PMID: 26148171 DOI: 10.1097/eja.0000000000000291] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung transplantation is the treatment of choice for end-stage pulmonary diseases. In order to avoid or reduce pulmonary and systemic complications, mechanical ventilator settings have an important role in each stage of lung transplantation. In this respect, the use of mechanical ventilation with a tidal volume of 6 to 8 ml kg(-1) predicted body weight, positive end-expiratory pressure of 6 to 8 cmH2O and a plateau pressure lower than 30 cmH2O has been suggested for the donor during surgery, and for the recipient both during and after surgery. For the present review, we systematically searched the PubMed database for articles published from 2000 to 2014 using the following keywords: lung transplantation, protective mechanical ventilation, lung donor, extracorporeal membrane oxygenation, recruitment manoeuvres, extracorporeal CO2 removal and noninvasive ventilation.
Collapse
|
14
|
Liu Z, Liu X, Huang Y, Zhao J. Intraoperative mechanical ventilation strategies in patients undergoing one-lung ventilation: a meta-analysis. SPRINGERPLUS 2016; 5:1251. [PMID: 27536534 PMCID: PMC4972804 DOI: 10.1186/s40064-016-2867-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 07/19/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Postoperative pulmonary complications (PPCs), which are not uncommon in one-lung ventilation, are among the main causes of postoperative death after lung surgery. Intra-operative ventilation strategies can influence the incidence of PPCs. High tidal volume (V T) and increased airway pressure may lead to lung injury, while pressure-controlled ventilation and lung-protective strategies with low V T may have protective effects against lung injury. In this meta-analysis, we aim to investigate the effects of different ventilation strategies, including pressure-controlled ventilation (PCV), volume-controlled ventilation (VCV), protective ventilation (PV) and conventional ventilation (CV), on PPCs in patients undergoing one-lung ventilation. We hypothesize that both PV with low V T and PCV have protective effects against PPCs in one-lung ventilation. METHODS A systematic search (PubMed, EMBASE, the Cochrane Library, and Ovid MEDLINE; in May 2015) was performed for randomized trials comparing PCV with VCV or comparing PV with CV in one-lung ventilation. Methodological quality was evaluated using the Cochrane tool for risk. The primary outcome was the incidence of PPCs. The secondary outcomes included the length of hospital stay, intraoperative plateau airway pressure (Pplateau), oxygen index (PaO2/FiO2) and mean arterial pressure (MAP). RESULTS In this meta-analysis, 11 studies (436 patients) comparing PCV with VCV and 11 studies (657 patients) comparing PV with CV were included. Compared to CV, PV decreased the incidence of PPCs (OR 0.29; 95 % CI 0.15-0.57; P < 0.01) and intraoperative Pplateau (MD -3.75; 95 % CI -5.74 to -1.76; P < 0.01) but had no significant influence on the length of hospital stay or MAP. Compared to VCV, PCV decreased intraoperative Pplateau (MD -1.46; 95 % CI -2.54 to -0.34; P = 0.01) but had no significant influence on PPCs, PaO2/FiO2 or MAP. CONCLUSIONS PV with low V T was associated with the reduced incidence of PPCs compared to CV. However, PCV and VCV had similar effects on the incidence of PPCs.
Collapse
Affiliation(s)
- Zhen Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, 1#Shuai fuyuan, Dongcheng District, Beijing, 100730 China
| | - Xiaowen Liu
- Department of Anesthesiology, Peking Union Medical College Hospital, 1#Shuai fuyuan, Dongcheng District, Beijing, 100730 China ; Department of Anesthesiology, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 33# Shijingshan District, Beijing, 100144 China
| | - Yuguang Huang
- Department of Anesthesiology, Peking Union Medical College Hospital, 1#Shuai fuyuan, Dongcheng District, Beijing, 100730 China
| | - Jing Zhao
- Department of Anesthesiology, Peking Union Medical College Hospital, 1#Shuai fuyuan, Dongcheng District, Beijing, 100730 China
| |
Collapse
|
15
|
Choi YS, Bae MK, Kim SH, Park JE, Kim SY, Oh YJ. Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position. Yonsei Med J 2015; 56:1421-7. [PMID: 26256990 PMCID: PMC4541677 DOI: 10.3349/ymj.2015.56.5.1421] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 11/17/2014] [Accepted: 11/21/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hypoxemia during one-lung ventilation (OLV) remains a serious problem, particularly in the supine position. We investigated the effects of alveolar recruitment (AR) and positive end-expiratory pressure (PEEP) on oxygenation during OLV in the supine position. MATERIALS AND METHODS Ninety-nine patients were randomly allocated to one of the following three groups: a control group (ventilation with a tidal volume of 8 mL/kg), a PEEP group (the same ventilatory pattern with a PEEP of 8 cm H₂O), or an AR group (an AR maneuver immediately before OLV followed by a PEEP of 8 cm H₂O). The tidal volume was reduced to 6 mL/kg during OLV in all groups. Blood gas analyses, respiratory variables, and hemodynamic variables were recorded 15 min into TLV (TLV(baseline)), 15 and 30 min after OLV (OLV₁₅ and OLV₃₀), and 10 min after re-establishing TLV (TLV(end)). RESULTS Ultimately, 92 patients were analyzed. In the AR group, the arterial oxygen tension was higher at TLV(end), and the physiologic dead space was lower at OLV₁₅ and TLV(end) than in the control group. The mean airway pressure and dynamic lung compliance were higher in the PEEP and AR groups than in the control group at OLV₁₅, OLV₃₀, and TLV(end). No significant differences in hemodynamic variables were found among the three groups throughout the study period. CONCLUSION Recruitment of both lungs with subsequent PEEP before OLV improved arterial oxygenation and ventilatory efficiency during video-assisted thoracic surgery requiring OLV in the supine position.
Collapse
Affiliation(s)
- Yong Seon Choi
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Kyung Bae
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Shin Hyung Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji-Eun Park
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Young Kim
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Jun Oh
- Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
16
|
Qutub H, El-Tahan MR, Mowafi HA, El Ghoneimy YF, Regal MA, Al Saflan AA. Effect of tidal volume on extravascular lung water content during one-lung ventilation for video-assisted thoracoscopic surgery: a randomised, controlled trial. Eur J Anaesthesiol 2014; 31:466-73. [PMID: 24690891 DOI: 10.1097/eja.0000000000000072] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The use of low tidal volume during one-lung ventilation (OLV) has been shown to attenuate the incidence of acute lung injury after thoracic surgery. OBJECTIVE To test the effect of tidal volume during OLV for video-assisted thoracoscopic surgery on the extravascular lung water content index (EVLWI). DESIGN A randomised, double-blind, controlled study. SETTING Single university hospital. PARTICIPANTS Thirty-nine patients scheduled for elective video-assisted thoracoscopic surgery. INTERVENTIONS Patients were randomly assigned to one of three groups (n = 13 per group) to ventilate the dependent lung with a tidal volume of 4, 6 or 8 ml kg(-1) predicted body weight with I:E ratio of 1:2.5 and PEEP of 5 cm H2O. MAIN OUTCOME MEASURES The primary outcomes were perioperative changes in EVLWI and EVLWI to intrathoracic blood volume index (ITBVI) ratio. Secondary outcomes included haemodynamics, oxygenation indices, incidences of postoperative acute lung injury, atelectasis, pneumonia, morbidity and 30-day mortality. RESULTS A tidal volume of 4 compared with 6 and 8 ml kg(-1) after 45 min of OLV resulted in an EVLWI of 4.1 [95% confidence interval (CI) 3.5 to 4.7] compared with 7.7 (95% CI 6.7 to 8.6) and 8.6 (95% CI 7.5 to 9.7) ml kg(-1), respectively (P < 0.003). EVLWI/ITBVI ratios were 0.57 (95% CI 0.46 to 0.68) compared with 0.90 (95% CI 0.75 to 1.05) and 1.00 (95% CI 0.80 to 1.21), respectively (P < 0.05). The incidences of postoperative acute lung injury, atelectasis, pneumonia, morbidity, hospitalisation and 30-day mortality were similar in the three groups. CONCLUSION The use of a tidal volume of 4 ml kg during OLV was associated with less lung water content than with larger tidal volumes of 6 to 8 ml kg(-1), although no patient developed acute lung injury. Further studies are required to address the usefulness of EVLWI as a marker for the development of postoperative acute lung injury after the use of a low tidal volume during OLV in patients undergoing pulmonary resection. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT01762709.
Collapse
Affiliation(s)
- Hatem Qutub
- From the Department of Critical Care & Pulmonary Medicine, Department of Medicine (H-Q), Department of Anaesthesia and Surgical ICU (MR-ET, HA-M, AA-AS), and Department of Cardiothoracic Surgery (YF-EG, MA-R), King Fahd Hospital of the University of Dammam, Al Khubar, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
17
|
Trepte CJ, Haas SA, Nitzschke R, Salzwedel C, Goetz AE, Reuter DA. Prediction of Volume-Responsiveness During One-Lung Ventilation: A Comparison of Static, Volumetric, and Dynamic Parameters of Cardiac Preload. J Cardiothorac Vasc Anesth 2013; 27:1094-100. [DOI: 10.1053/j.jvca.2013.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Indexed: 11/11/2022]
|
18
|
Current World Literature. Curr Opin Anaesthesiol 2013; 26:98-104. [DOI: 10.1097/aco.0b013e32835cb4f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Intraoperative protective ventilation strategies in lung transplantation. Transplant Rev (Orlando) 2013; 27:30-5. [DOI: 10.1016/j.trre.2012.11.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 11/16/2012] [Indexed: 01/03/2023]
|
20
|
Karzai W, Klein U. FIO2 and studies on oxygenation during one-lung ventilation. Br J Anaesth 2012; 109:644; author reply 644-5. [PMID: 22976860 DOI: 10.1093/bja/aes329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Rozé H. Reply from the authors. Br J Anaesth 2012. [DOI: 10.1093/bja/aes330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|