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Positive end-expiratory pressure applied to the dependent lung during one-lung ventilation improves oxygenation and respiratory mechanics in patients with high FEV1

Published online by Cambridge University Press:  28 January 2005

F. Valenza ,
G. Ronzoni ,
L. Perrone ,
M. Valsecchi ,
S. Sibilla ,
M. Nosotti ,
L. Santambrogio ,
B. M. Cesana  and
L. Gattinoni
F. Valenza
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
G. Ronzoni
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
L. Perrone
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
M. Valsecchi
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
S. Sibilla
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
M. Nosotti
Affiliation:
Istituto di Chirurgia Toracica, Milan, Italy
L. Santambrogio
Affiliation:
Istituto di Chirurgia Toracica, Milan, Italy
B. M. Cesana
Affiliation:
Laboratorio epidemiologico – Direzione scientifica, Milan, Italy
L. Gattinoni
Affiliation:
Istituto di Anestesia e Rianimazione, Milan, Italy
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Extract

Summary

Background and objective: The aim of this study was to test the efficacy of positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation, taking into consideration underlying lung function in order to select responders to PEEP.

Methods: Forty-six patients undergoing open-chest thoracic surgical procedures were studied in an operating room of a university hospital. Patients were randomized to receive zero end-expiratory pressure (ZEEP) or 10 cmH2O of PEEP to the dependent lung during one-lung ventilation in lateral decubitus. The patients were stratified according to preoperative forced expiratory volume in 1 s (FEV1) as an indicator of lung function (below or above 72%). Oxygenation was measured in the supine position, in the lateral decubitus with an open chest, and after 20 min of ZEEP or PEEP. The respiratory system pressure–volume curve of the dependent hemithorax was measured in supine and open-chest lateral decubitus positions with a super-syringe.

Results: Application of 10 cmH2O of PEEP resulted in a significant increase in PaO2 (P < 0.05). This did not occur in ZEEP group, considered as a time matched control. PEEP improved oxygenation only in patients with high FEV1 (from 11.6 ± 4.8 to 15.3 ± 7.1 kPa, P < 0.05). There was no significant change in the low FEV1 group. Dependent hemithorax compliance decreased in lateral decubitus, more in patients with high FEV1 (P < 0.05). PEEP improved compliance to a greater extent in patients with high FEV1 (from 33.6 ± 3.6 to 48.4 ± 3.9 mL cmH2O−1, P < 0.05).

Conclusions: During one-lung ventilation in lateral decubitus, PEEP applied to the dependent lung significantly improves oxygenation and respiratory mechanics in patients with rather normal lungs as assessed by high FEV1.

Keywords

RESPIRATION, ARTIFICIAL, intermittent positive pressure ventilation, positive pressure respiration, one-lung ventilationRESPIRATORY MECHANICSRESPIRATORY FUNCTION TESTS, lung compliance, pulmonary gas exchangeTHORACIC SURGERYPOSTURE, lateral position
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 12 , December 2004 , pp. 938 - 943
Copyright
© 2004 European Society of Anaesthesiology

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