Application of Continuous Positive Airway Pressure During Video-Assisted Thoracoscopic Surgery

Abstract

Purpose of Review Video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS) are used for anatomic resection of early stage cancer. These surgical techniques require the use of one-lung ventilation (OLV). During OLV, an obligatory intrapulmonary shunt may produce hypoxemia. One method to correct hypoxemia is with the use of continuous positive airway pressure (CPAP). This review focuses on 1) the lung physiology of OLV; 2) application of CPAP in VATS or RATS during supine and lateral position; and 3) the application of CPAP in COVID-19 patients during OLV. Recent Findings Studies have shown the beneficial effects of CPAP to improve oxygenation during OLV while the patient is in the lateral decubitus position. In contrast, studies have shown no benefit on improving oxygenation with CPAP in patients undergoing OLV in supine position. Summary The application of CPAP to the non-dependent lung is one of the options to treat hypoxemia during VATS or RATS.

Effects of Iloprost on Oxygenation during One-Lung Ventilation in Patients with Low Diffusing Capacity for Carbon Monoxide: A Randomized Controlled Study

“…However, OLV aggravates ventilation–perfusion (V/Q) mismatch and commonly results in hypoxemia, which has an incidence of 5–10% [ 1 ]. Hypoxemia of the nonventilated lung triggers hypoxic pulmonary vasoconstriction (HPV), an autoregulatory mechanism that decreases the shunt fraction by diverting total pulmonary blood flow from the nonventilated lung to the ventilated lung [ 2 , 3 ].…”