Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test
Korean Journal of Anesthesiology 2014³â 67±Ç 2È£ p.96 ~ p.102
Á¤Á¾´Þ(Jung Jong-Dal) - Chosun University School of Medicine Department of Anesthesiology and Pain Medicine
±è»óÈÆ(Kim Sang-Hun) - Chosun University School of Medicine Department of Anesthesiology and Pain Medicine
À¯º´½Ä(Yu Byung-Sik) - Chosun University School of Medicine Department of Anesthesiology and Pain Medicine
±èÇýÁö(Kim Hye-Ji) - Chosun University Hospital Department of Anesthesiology and Pain Medicine
Abstract
Background: Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP).
Methods: In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began.
Results: Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05).
Conclusions: Preemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.
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Alveolar recruitment, One-lung ventilation, Oxygenation, PEEP, Preemptive, Tidal volume
KMID :
0356920140670020096
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