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Ann Thorac Surg 2002;73:1204-1209
© 2002 The Society of Thoracic Surgeons
a Department of Anesthesiology Hospital Privado de Comunidad, Mar del Plata, Argentina
b Department of Surgery Hospital Privado de Comunidad, Mar del Plata, Argentina
c Intensive Care Medicine, Hospital Privado de Comunidad, Mar del Plata, Argentina
d Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Accepted for publication December 12, 2001.
* Address reprint requests to Dr Tusman, Department of Anesthesiology, Hospital Privado de Comunidad, Cordoba 4545, 7600 Mar del Plata, Argentina
e-mail: gtusman{at}hotmail.com
Background. Deterioration of gas exchange during one lung ventilation (OLV) is caused by both total collapse of the nondependent lung and partial collapse of the dependent lung. A previous report demonstrated that an alveolar recruitment strategy (ARS) improves lung function during general anesthesia in supine patients. The objective of this article was to study the impact of this ARS on arterial oxygenation in patients undergoing OLV for lobectomies.
Methods. Ten patients undergoing open lobectomies were studied at three time points: (1) during two-lung ventilation (TLV), (2) during OLV before, and (3) after ARS. The ARS maneuver was done by increasing peak inspiratory pressure to 40 cm H2O, together with a positive end-expiratory pressure (PEEP) of 20 cm H2O for 10 respiratory cycles. After the maneuver, ventilation parameters were returned to the settings before intervention.
Results. During OLV, PaO2 was statistically lower before the recruitment (data as median, first, and third quartile, 217 [range 134 to 325] mm Hg) compared with OLV afterwards (470 [range 396 to 525] mm Hg) and with TLV (515 [range 442 to 532] mm Hg). After ARS, PaO2 values during OLV were similar to those during TLV. During OLV, the degree of pulmonary collapse in the nondependent lung, the hemodynamic status, and the ventilation parameters were similar before and after ARS.
Conclusions. Alveolar recruitment of the dependent lung augments PaO2 values during one-lung ventilation.
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G. Tusman, F. Melkun, D. Staltari, C. Quinzio, C. Nador, E. Turchetto, and S. H. Bohm Alveolar recruitment during one-lung ventilation--really "one" lung?: Reply Ann. Thorac. Surg., February 1, 2003; 75(2): 635 - 636. [Full Text] [PDF]
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