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Effects of Alveolar Recruitment and Positive End-Expiratory Pressure on Oxygenation during One-Lung Ventilation in the Supine Position

 Yong Seon Choi  ;  Mi Kyung Bae  ;  Shin Hyung Kim  ;  Ji-Eun Park  ;  Soo Young Kim  ;  Young Jun Oh 
 YONSEI MEDICAL JOURNAL, Vol.56(5) : 1421-1427, 2015 
Journal Title
Issue Date
Adult ; Aged ; Female ; Humans ; Hypoxia ; Lung/physiopathology ; Lung Compliance/physiology ; Male ; Middle Aged ; One-Lung Ventilation/methods* ; Oxygen/blood* ; Positive-Pressure Respiration/methods* ; Pulmonary Alveoli/physiology* ; Pulmonary Gas Exchange ; Respiratory Mechanics/physiology* ; Supine Position* ; Thoracic Surgery, Video-Assisted ; Tidal Volume
Alveolar recruitment ; one-lung ventilation ; positive end-expiratory pressure ; supine position
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.
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1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Shin Hyung(김신형) ORCID logo https://orcid.org/0000-0003-4058-7697
Park, Ji Eun(박지은)
Bae, Mi Kyung(배미경)
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
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