An anesthesiologist's guide to hypoxic pulmonary vasoconstriction: implications for managing single-lung anesthesia and atelectasis

Nagendran, Jayan; Stewart, Ken G.; Hoskinson, Michael; Archer, Stephen L.

doi:10.1097/01.aco.0000192777.09527.9e

Cited by 63 publications

(40 citation statements)

References 84 publications

(90 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…HPV is critical to single-lung anesthesia for patients undergoing thoracic surgery such as lung tumor resections. 48 During these procedures, the patient is positioned on the side to facilitate surgical dissection, and single-lung ventilation is initiated using a doublelumen endobronchial tube (Fig 5A). During tube placement, the proximal and distal lumen tips are positioned above the carina and in the primary bronchus of the target lung, respectively (Fig 5B).…”

Section: Clinical Relevance Of Hpvmentioning

confidence: 99%

Hypoxic Pulmonary Vasoconstriction

Dunham‐Snary

Sykes

et al. 2017

Chest

Self Cite

338

144

View full text Add to dashboard Cite

Hypoxic pulmonary vasoconstriction (HPV) is a homeostatic mechanism that is intrinsic to the pulmonary vasculature. Intrapulmonary arteries constrict in response to alveolar hypoxia, diverting blood to better-oxygenated lung segments, thereby optimizing ventilation/perfusion matching and systemic oxygen delivery. In response to alveolar hypoxia, a mitochondrial sensor dynamically changes reactive oxygen species and redox couples in pulmonary artery smooth muscle cells (PASMC). This inhibits potassium channels, depolarizes PASMC, activates voltage-gated calcium channels, and increases cytosolic calcium, causing vasoconstriction. Sustained hypoxia activates rho kinase, reinforcing vasoconstriction, and hypoxia-inducible factor (HIF)-1a, leading to adverse pulmonary vascular remodeling and pulmonary hypertension (PH). In the nonventilated fetal lung, HPV diverts blood to the systemic vasculature. After birth, HPV commonly occurs as a localized homeostatic response to focal pneumonia or atelectasis, which optimizes systemic PO 2 without altering pulmonary artery pressure (PAP). In single-lung anesthesia, HPV reduces blood flow to the

show abstract

Section: Clinical Relevance Of Hpvmentioning

confidence: 99%

Hypoxic Pulmonary Vasoconstriction

Dunham‐Snary

Sykes

et al. 2017

Chest

Self Cite

338

144

View full text Add to dashboard Cite

show abstract

“…Various factors are important in limiting shunt during OLA. These include HPV [20 ] that limits nonventilated lung shunt, administration of positive end-expiratory pressure (PEEP) to the dependent lung [21][22][23] and correct positioning of double lumen tubes [24]. A number of authors have demonstrated the benefit of dependent lung PEEP when titrated to restore functional residual capacity [21,22,25], whereas administration of predetermined [26] or excessive amounts of PEEP [22] does not always improve arterial oxygenation.…”

Section: Shunt Fractionmentioning

confidence: 99%

Arterial oxygenation and one-lung anesthesia

Levin

Coetzee

2008

Current Opinion in Anaesthesiology

View full text Add to dashboard Cite

The effects of anesthesia techniques on oxygen consumption, cardiac output and therefore mixed venous oxygenation can significantly affect arterial oxygenation during one-lung anesthesia. While pursuing increases in cardiac output may, under limited circumstances, benefit arterial oxygenation during one-lung ventilation, this approach is not a panacea and does not obviate the necessity to optimize dependent lung volume.

show abstract

“…The effectivity of HPV is influenced by the lung volume. If the delivered tidal volumes and intrapulmonary pressures overstretch the ventilated alveoli, blood flow may be diverted to the nonventilated alveoli attenuating the HPV response and leading to increased V/Q mismatch and worsening hypoxemia (11).…”

Section: Discussionmentioning

confidence: 99%

Non-intubated anaesthetic technique in open bilobectomy in a patient with severely impaired lung function

Szabó¹,

Tánczos²,

Lebák³

et al. 2018

J. Thorac. Dis.

View full text Add to dashboard Cite

General anaesthesia has been the most commonly used method for almost all types of thoracic surgery. Recently, there has been a growing interest in non-intubated anaesthetic techniques. The rationale being, to prevent complications related to general anaesthesia and positive pressure ventilation such as barotrauma or ventilation-perfusion mismatch. We present a case with severely impaired forced expiration volume (26%), carbon monoxide diffusing capacity (26%) and VO 2 max (13.9 mL/kg/min). According to current guidelines, this patient was suitable to undergo one-lung ventilation only with high risk of morbidity and mortality. Therefore, we chose the non-intubated technique for thoracotomy. Oxygenation was satisfactory throughout, the patient remained hemodynamically stable and the operation was uneventful.Oxygen supplementation was stopped from day 2 and he was discharged on day 7. To our knowledge, this is the first case report where a planned non-intubated method was applied for thoracotomy, and our results suggest that it might be a feasible and safe approach for open thoracotomy in difficult cases where severely impaired lung function indicates that one lung ventilation may carry significant risks.

show abstract

An anesthesiologist's guide to hypoxic pulmonary vasoconstriction: implications for managing single-lung anesthesia and atelectasis

Abstract: An understanding of hypoxic pulmonary vasoconstriction is clinically relevant for anesthesiologists. Randomized clinical trials with robust endpoints are required to assess strategies for enhancing hypoxic pulmonary vasoconstriction in thoracic surgery patients.

Cited by 63 publications

References 84 publications

Hypoxic Pulmonary Vasoconstriction

Hypoxic Pulmonary Vasoconstriction

Arterial oxygenation and one-lung anesthesia

Non-intubated anaesthetic technique in open bilobectomy in a patient with severely impaired lung function

Contact Info

Product

Resources

About