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Effect of permissive hypercarbia on lung oxygenation during one-lung ventilation and postoperative pulmonary complications in patients undergoing thoracic surgery: A prospective randomised controlled trial

 Young-Eun Joe  ;  Chang Yeong Lee  ;  Namo Kim  ;  Kyuho Lee  ;  Su Jeong Kang  ;  Young Jun Oh 
 EUROPEAN JOURNAL OF ANAESTHESIOLOGY, Vol.40(9) : 691-698, 2023-09 
Journal Title
Issue Date
Humans ; Hypercapnia ; Lung / surgery ; One-Lung Ventilation* / adverse effects ; Oxygen ; Postoperative Complications / diagnosis ; Postoperative Complications / epidemiology ; Postoperative Complications / etiology ; Prospective Studies ; Respiration, Artificial / adverse effects ; Thoracic Surgery* ; Tidal Volume
Background: The effect of hypercarbia on lung oxygenation during thoracic surgery remains unclear.

Objective: To investigate the effect of hypercarbia on lung oxygenation during one-lung ventilation in patients undergoing thoracic surgery and evaluate the incidence of postoperative pulmonary complications.

Design: Prospective randomised controlled trial.

Setting: A tertiary university hospital in the Republic of Korea from November 2019 to December 2020.

Patients: Two hundred and ninety-seven patients with American Society of Anaesthesiologists physical status II to III, scheduled to undergo elective lung resection surgery.

Intervention: Patients were randomly assigned to Group 40, 50, or 60. An autoflow ventilation mode with a lung protective ventilation strategy was applied to all patients. Respiratory rate was adjusted to maintain a partial pressure of arterial carbon dioxide of 40 ± 5 mmHg in Group 40, 50 ± 5 mmHg in Group 50 and 60 ± 5 mmHg in Group 60 during one-lung ventilation and at the end of surgery.

Main outcome measures: The primary outcome was the arterial oxygen partial pressure/fractional inspired oxygen ratio after 60 min of one-lung ventilation.

Results: Data from 262 patients were analysed. The partial pressure/fractional inspired oxygen ratio was significantly higher in Group 50 and Group 60 than in Group 40 (269.4 vs. 262.9 vs. 214.4; P < 0.001) but was not significantly different between Group 50 and Group 60. The incidence of postoperative pulmonary complications was comparable among the three groups.

Conclusion: Permissive hypercarbia improved lung oxygenation during one-lung ventilation without increasing the risk of postoperative pulmonary complications or the length of hospital stay.

Trial registration: NCT04175379.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Namo(김남오) ORCID logo https://orcid.org/0000-0002-0829-490X
Oh, Young Jun(오영준) ORCID logo https://orcid.org/0000-0002-6258-5695
Lee, Kyuho(이규호)
Lee, Chang Young(이창영)
Joe, Young Eun(조영은) ORCID logo https://orcid.org/0000-0002-5848-5843
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