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Effects of head-down tilt on intrapulmonary shunt fraction and oxygenation during one-lung ventilation in the lateral decubitus position

Authors
 Yong Seon Choi  ;  Sou Ouk Bang  ;  Yong Woo Hong  ;  Young Lan Kwak  ;  Kyung Young Chung  ;  Jae Kwang Shim 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.134(3) : 613-618, 2007 
Journal Title
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 
ISSN
 0022-5223 
Issue Date
2007
MeSH
Female ; Head-Down Tilt* ; Humans ; Male ; Middle Aged ; Posture* ; Respiration, Artificial/methods*
Abstract
OBJECTIVE: During one-lung ventilation, surgical positions significantly affect deterioration of oxygenation, and the lateral decubitus position is superior in preventing dangerous hypoxemia compared with the supine position. However, additional head-down tilt causes more compression of the dependent ventilated lung by the abdominal contents and may result in dangerous hypoxemia, as occurs in the supine position. Therefore, we evaluated the effect of head-down tilt on intrapulmonary shunt and oxygenation during one-lung ventilation in the lateral decubitus position. METHODS: Thirty-four patients requiring one-lung ventilation were randomly allocated to the control group (n = 17) or the head-down tilt group (n = 17). Hemodynamic and respiratory variables were measured 15 minutes after one-lung ventilation in the lateral decubitus position (baseline), 5 and 10 minutes after a 10-degree head-down tilt (T5 and T10, respectively), and 10 minutes after the patient was returned to a horizontal position (T20) in the head-down tilt group. Measurements were done at the same time points in the control group without head-down tilting. RESULTS: In the head-down tilt group, cardiac filling pressures were increased after head-down tilt without any changes in cardiac index. Percent change of shunt to baseline value was significantly increased at T10 and T20 in the head-down tilt group. Percent change of arterial oxygen tension to baseline value was significantly decreased at T5, T10, and T20 in the head-down tilt group, whereas it was decreased only at T20 in the control group. CONCLUSION: Head-down tilt during one-lung ventilation in the lateral decubitus position caused a significant increase in shunt and a decrease in percent change of arterial oxygen tension, without causing dangerous hypoxemia.
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522307009051
DOI
10.1016/j.jtcvs.2007.05.018
Appears in Collections:
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
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Bang, Sou Ouk(방서욱)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Chung, Kyung Young(정경영)
Choi, Yong Seon(최용선) ORCID logo https://orcid.org/0000-0002-5348-864X
Hong, Yong Woo(홍용우)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/96703
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