Appropriate Ventilatory Settings for Thoracic Surgery: Intraoperative and Postoperative

Abstract

Mechanical ventilation of patients undergoing thoracic surgery is often challenging. These patients frequently have significant underlying comorbidities, including cardiopulmonary disease, and often must undergo 1-lung ventilation. Perioperative respiratory complications are common and are multifactorial in etiology. Increasing evidence suggests that mechanical ventilation is associated with, and may even cause, lung damage in both sick and healthy patients. Gas exchange to provide acceptable end-organ oxygenation remains a primary goal but so too is minimization of risks for acute lung injury. Every ventilator strategy is associated with potential beneficial and adverse side effects. Understanding the impact of various ventilation strategies allows clinicians to provide optimal care for patients.

Alternating one lung ventilation using a double lumen endobronchial tube and providing CPAP to the non-ventilated lung in a dog

“…Multimodal strategies have been suggested to treat and prevent hypoxaemia during OLV (Lytle & Brown 2008). These include the use of PEEP, CPAP and recruitment maneuvers.…”

“…Hypoxemia, especially, is a difficult problem for the anaesthesiologist to manage. Several strategies, including the use of high inspired fraction of oxygen (FiO 2 ) (Lytle & Brown 2008), the application of positive end expiratory pressure (PEEP) to the ventilated lung (Fujiwara et al. 2001; Grichnik & Shaw 2009), and the application of continuous positive airway pressure (CPAP) to the non‐ventilated lung (Fujiwara et al.…”

Protective Ventilatory Approaches to One-Lung Ventilation: More than Reduction of Tidal Volume

“…Mechanical stress by hyperinflation, hyperperfusion and cyclic recruitment/de-recruitment in combination with proinflammatory or biochemical factors is thought to contribute to ALI. One can postulate a 'multiple-hit' theory including surgery-related factors, one-lung ventilation, underlying diseases and co-morbidity, prior therapy and other unidentified events for thoracic surgery patients that may increase susceptibility to ALI [64].…”

Intraoperative plateau pressure measurement using modern anesthesia machine ventilators

“…4,5 Whenever chest compliance is reduced, the stiff chest contributes substantially to Pplat. This should be taken into consideration when assessing lung stretch, as higher Pplat may still be safe due to the limitation of alveolar distension by the chest wall.…”