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Ann Thorac Surg 2003;75:635
© 2003 The Society of Thoracic Surgeons

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Correspondence

Alveolar recruitment during one-lung ventilation—really "one" lung?

Mert entürk, MD, Mehmet Turul, MD

Department of Anesthesiology, Medical Faculty of Istanbul University of IstanbulÇapa 34390 Istanbul, Turkey

e-mail: senturkem{at}superonline.com

To the Editor:

We read with interest the recent article by Tusman and colleagues [1] and have two points to make.

First, intermittent two-lung ventilation is one method to overcome hypoxia during one-lung ventilation (OLV). However, as pointed out in the study, this technique can interfere with the operation. Although part of the surgical protocol, the method described by the authors is principally interruption of OLV when both lungs are ventilated. Therefore, this method is applicable only at a specific time, ie, during expansion after lobectomy. Otherwise, two-lung ventilation with an interruption of the surgical procedure for about 4 minutes is an important disadvantage. Also, we think that a comparison between the "alveolar recruitment strategy" and "routine" interruption of OLV lasting 4 minutes is more appropriate for evaluating the recruitment method. Second, pressure-controlled ventilation is a preferred method of OLV to avoid high inspiratory pressures and to achieve an appropriate match between ventilation and perfusion [2]. Although pressure-controlled ventilation is also used during recruitment, inspiratory pressures as high as 40 cm H₂O have been reached. Both hypoxia and high respiratory pressures should be avoided during OLV [3]. The strategy described in the study should also address whether short periods of high inspiratory pressures can cause lung injury.

References

1. Tusman G., Böhm S.T., Melkun F., et al. Alveolar recruitment strategy increases arterial oxygenation during one-lung ventilation. Ann Thorac Surg 2002;73:1204-1209.[Abstract/Free Full Text]
2. Tugrul M., Çamc E., Karadeniz H., entürk M., Pembeci K., Akpir K. Comparison of volume controlled with pressure controlled ventilation during one-lung anaesthesia. Br J Anaesth 1997;79:306-310.[Abstract/Free Full Text]
3. Jordan S., Mitchell J.A., Quinlan G.J., Goldstraw P., Evans T.W. The pathogenesis of lung injury following pulmonary resection. Eur Respir J 2000;15:790-799.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Sentürk, M. Articles by Tugrul, M. Search for Related Content PubMed Articles by Sentürk, M. Articles by Tugrul, M. Related Collections Anesthesia