Arterial oxygenation and one-lung anesthesia

Levin, Andrew; Coetzee, J. F.; Coetzee, André

doi:10.1097/aco.0b013e3282f2bb79

Cited by 21 publications

(14 citation statements)

References 99 publications

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“…Lower peripheral resistance was noted in the PHC group, and non-oxygenated blood shunting was comparable in both groups. The obtained results confirm the vasoconstrictive effect of hypercapnia on pulmonary circulation, which results in the intensification of HPV [30]. Adrenergic activity, resulting from respiratory acidosis, causes an increase in the cardiac index and mean arterial pressure.…”

Section: Kardiochirurgia I Torakochirurgia Polska 2013; 10 (4)supporting

confidence: 71%

“…While using HFJV, the efficient elimination of carbon dioxide is conditioned on respiratory cycle frequency, drive pressure (DP), and the ratio between inhalation and exhalation times [30]. High breathing frequency, short inhalation time, and low drive pressures contribute to carbon dioxide retention.…”

Section: Kardiochirurgia I Torakochirurgia Polska 2013; 10 (4)mentioning

confidence: 99%

“…Controlled hypercapnia developed during hypoventilation is an advantageous phenomenon, as it intensifies hypoxic pulmonary vasoconstriction, probably due to the intensification of acidosis. However, uncontrolled progressive hypercapnia becomes a problem, as it increases vascular bed resistance in the lower lung and restricts the redistribution of blood from the unventilated upper lung [2][3][4].…”

mentioning

confidence: 99%

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Anaesthesiology and intensive care Hemodynamic consequences of different ventilation methods used in lung surgery

Misiołek¹,

Budziński²,

Karpe³

et al. 2013

kitp

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StreszczenieTechniki znieczulenia i wentylacji do operacji torakochirurgicznych są zdecydowanie odmienne od stosowanych w chirurgii ogólnej. Standardową metodą wentylacji podczas dużych zabiegów torakochirurgicznych dotyczących miąższu płucnego oraz innych narządów klatki piersiowej jest wentylacja jednego płuca (one lung ventilation -OLV). Najczęściej zabiegi przeprowadza się w ułożeniu pacjenta na boku przeciwnym do operowanego z równoczesnym otwarciem klatki piersiowej (odma otwarta). To wszystko implikuje zaburzenia mechaniki oddychania, hemodynamiki oraz utlenowania krwi. Alternatywną metodą jest wentylacja wysokimi częstotliwościami (high-frequency jet ventilation -HFJV). Obie metody wentylacji zapewniają całkowite lub częściowe unieruchomienie pola operacyjnego, ale odmienne skutki hemodynamiczne. Porównując obie techniki wentylacji ze względu na zachowanie się parametrów układu sercowo-naczyniowego, można zdecydowanie stwierdzić, że HFJV zapewniając lepsze utlenowanie i prawidłową wentylację, utrzymuje stabilność hemodynamiczną w porównaniu z wentylacją OLV. Słowa kluczowe: wentylacja jednym płucem, wentylacja wysokimi częstotliwościami, układ sercowo-naczyniowy. ANAESTHESIOLOGY AND INTENSIVE CARE AbstractAnesthesia techniques used in thoracic surgery are completely different from those used in general surgery, because thoracic surgery requires both effective ventilation and immobilization of the operating area. One lung ventilation (OLV) remains the standard ventilation method used during thoracic surgery procedures. The most frequent position of the patient during thoracotomy is the lateral decubitus position opposite to the operated side. The abovementioned conditions lead to several respiratory, hemodynamic, and oxygenation disturbances. However, high-frequency jet ventilation (HFJV) may be used as an alternative way of ventilation during lung resection. Both ventilation methods provide full or partial immobilization of the operative field, but they result in different hemodynamic effects. Comparing the cardiovascular parameters during OLV and HFJV we can definitely say that HFJV provides better oxygenation and ventilation in comparison to OLV, while maintaining hemodynamic stability. Key words: one lung ventilation, high frequency jet ventilation, cardiovascular system. DOI: 10.5114/kitp.2013.39743 One lung ventilation (OLV) remains the standard method of providing ventilation during anesthesia before thoracic surgery procedures. The procedures are usually conducted with the patient in a lateral decubitus position opposite to the operated side, with concurrent opening of the chest (open pneumothorax), which allows for complete or partial immobilization of the operating field. Employing this method of ventilation, however, implies a change in the mechanics of breathing, hemodynamics, and blood oxygenation [1]. Hemodynamic consequences of different ventilation methods used in lung surgeryDuring one lung ventilation, the priority for the anesthesiologist is to protect the patient from hypoxia, caus...

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Section: Kardiochirurgia I Torakochirurgia Polska 2013; 10 (4)supporting

confidence: 71%

Section: Kardiochirurgia I Torakochirurgia Polska 2013; 10 (4)mentioning

confidence: 99%

mentioning

confidence: 99%

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Anaesthesiology and intensive care Hemodynamic consequences of different ventilation methods used in lung surgery

Misiołek¹,

Budziński²,

Karpe³

et al. 2013

kitp

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“…Sie kann die Perfusion auf bis zu 50% reduzieren, sodass die Shunt-Fraktion bei ELV auf ca. 20-30% des HZV kalkuliert werden muss [7,8,9,10,11] [12], sodass die arterielle Oxygenierung während ELV mit vom HZV abhän-gig ist. So zeigten klinische Studien, dass eine Erhöhung des HZV um 25%, die von einem gemischtvenösen Sättigungsanstieg von 60 auf 74,6% begleitet war, zu einer signifikanten Verbesserung der arteriellen Oxygenierung unter ELV führte [13,14].…”

Section: Hypoxische Pulmonale Vasokonstriktionunclassified

Hemodynamic monitoring in one-lung ventilation

et al. 2009

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One-lung ventilation causes adverse effects in pulmonary gas exchange and cardiocirculatory function. These adverse effects become particularly important for patients with underlying cardiopulmonary comorbidities. Alterations in pulmonary gas exchange have been investigated in several experimental and clinical trials. However, the hemodynamic consequences of one-lung ventilation are to a great extent unknown. Furthermore, no conclusive recommendations exist as to which kind of hemodynamic monitoring should be preferred in the situation of one-lung ventilation. Many issues regarding hemodynamic monitoring in one-lung ventilation remain unacknowledged. This article will review the current literature on hemodynamic monitoring in one-lung ventilation in order to derive recommendations for the application of hemodynamic monitoring in this specific peri-operative situation.

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“…1. The unfavorable ratios of local ventilation to perfusion (V/Q) created by both the total collapse of the operated/non-ventilated lung and the different states of aeration and perfusion in the ventilated lung lead to inefficiencies of gas exchange, witnessed clinically as hypoxemia and hypercapnia of different degrees [14,15].…”

Section: Gas Exchange During Thoracic Surgeries With Onelung Ventilationmentioning

confidence: 99%

Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

Tusman

Böhm

Suárez-Sipmann

2014

Curr Anesthesiol Rep

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Especially during thoracic surgery, anesthesiologists have to cope with both the drastic alteration of normal pulmonary physiology and the mechanical stress on the lung tissue induced by ventilation. These problems result from the total collapse of the lung being operated on and the partial collapse of the ventilated other lung. In addition, technical factors inherent to thoracic surgery and the patient's condition potentiate such adverse effects. Traditional ventilatory settings described for thoracic surgery have not led to a decrease in the incidence of hypoxemia or perioperative atelectasis. However, lung recruitment maneuvers and ventilatory strategies are aimed at resolving lung collapse in mechanically ventilated patients, improving lung function, and decreasing the rate of post-operative pulmonary complications directly related to lung collapse. This article summarizes recent evidence for the role that lung recruitment maneuvers play during one-lung ventilation anesthesia.

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Arterial oxygenation and one-lung anesthesia

Cited by 21 publications

References 99 publications

Anaesthesiology and intensive care Hemodynamic consequences of different ventilation methods used in lung surgery

Anaesthesiology and intensive care Hemodynamic consequences of different ventilation methods used in lung surgery

Hemodynamic monitoring in one-lung ventilation

Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

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