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Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in patients with low diffusion capacity of lung for carbon monoxide: a crossover study

Authors
 Kyuho Lee  ;  Young Jun Oh  ;  Yong Seon Choi  ;  Shin Hyung Kim 
Citation
 Journal of Clinical Anesthesia, Vol.27(6) : 445-450, 2015 
Journal Title
 Journal of Clinical Anesthesia 
ISSN
 0952-8180 
Issue Date
2015
MeSH
Adult ; Aged ; Carbon Monoxide/metabolism* ; Cross-Over Studies ; Female ; Humans ; Lung/metabolism* ; Lung/surgery ; Male ; Middle Aged ; One-Lung Ventilation/methods* ; Oxygen Inhalation Therapy/methods* ; Positive-Pressure Respiration ; Prospective Studies ; Pulmonary Diffusing Capacity* ; Respiratory Dead Space ; Respiratory Function Tests ; Respiratory Mechanics* ; Tidal Volume ; Young Adult
Keywords
One-lung ventilation ; inspiratory-expiratory ratio ; oxygenation ; respiratory mechanics
Abstract
STUDY OBJECTIVE: To investigate the effects of a 1:1 inspiratory-to-expiratory (I:E) ventilation ratio on oxygenation and respiratory mechanics during one-lung ventilation (OLV) in patients with low diffusion capacity of lung for carbon monoxide (DLCO). DESIGN: Prospective, randomized, crossover study. SETTING: Operating room, university hospital. PATIENTS: Twenty-six patients with a preoperative DLCO less than 80% who were scheduled for lung lobectomy requiring OLV under general anesthesia. INTERVENTIONS: In the first group (n = 13), OLV was begun with a 1:1 I:E ratio, which was switched to a 1:2 I:E ratio after 30 minutes. In the second group (n = 13), the modes of ventilation were performed in the opposite order. Pressure-controlled ventilation with 5 cm H2O of positive end-expiratory pressure and a tidal volume of 5 to 8 mL/kg was applied during OLV. MEASUREMENTS: Arterial and central venous blood gas analyses were recorded and used to calculate intrapulmonary shunt fraction and physiologic dead space. These measurements were taken at 4 time points: 10 minutes after two-lung ventilation in the lateral decubitus position, 30 minutes after initiation of OLV, 30 minutes after switching the I:E ratio, and 10 minutes after two-lung ventilation was resumed. MAIN RESULTS: There was no difference in arterial oxygen tension during OLV between the 2 groups (P = .429). Arterial carbon dioxide tension and peak airway pressure were lower in the 1:1 group than in the 1:2 group (P = .003; P = .008). Physiologic dead space was also decreased in the 1:1 I:E ratio group (P = .003). Mean airway pressure and dynamic compliance were higher in the 1:1 group (P = .003; P = .007). CONCLUSIONS: Pressure-controlled ventilation with a 1:1 I:E ventilation ratio did not improve oxygenation in patients with low DLCO during OLV compared with a 1:2 I:E ventilation ratio. However, it did provide benefits in terms of respiratory mechanics and increased the efficiency of alveolar ventilation during OLV.
Full Text
http://www.sciencedirect.com/science/article/pii/S095281801500197X
DOI
10.1016/j.jclinane.2015.06.012
Appears in Collections:
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
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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URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/157329
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