Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection

Liu, Wenjun; Huang, Qian; Lin, Duomao; Zhao, Lei; Ma, Jun

doi:10.21037/jtd.2018.04.90

Cited by 4 publications

(4 citation statements)

References 50 publications

(58 reference statements)

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“…Increasing pulmonary vascular resistance (PVR) is a double-blade sword, since it would not only augment right ventricular afterload and lessen L-R shunt [4], but also lead to the insufficient pulmonary oxygenation and deteriorate tissue oxygenation [5]. Therefore, the key regime of achieving better oxygenation in patients with L-R shunt is to balance the PVR for a favorable ratio of Qp/Qs [6, 7].…”

Section: Introductionmentioning

confidence: 99%

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

Zeng

Wei

et al. 2019

BMC Anesthesiol

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Background Increase of pulmonary vascular resistance (PVR) is an efficient method of modulating pulmonary and systemic blood flows (Qp/Qs) for patients with left-to-right (L-R) shunt, and is also closely associated with insufficient oxygen exchange for pulmonary hypoperfusion. So that it might be a preferred regime of maintaining arterial partial pressure of carbon dioxide tension (PaCO2) within an optimal boundary via ventilation management in congenital heart disease (CHD) patients for the inconvenient measure of the PVR and Qp/Qs. However, the appropriate range of PaCO2 and patient-specific mechanical ventilation settings remain controversial for CHD children with L-R shunt. Methods Thirty-one pediatric patients with L-R shunt, 1–6 yr of age, were included in this observation study. Patients were ventilated with tidal volume (VT) of 10, 8 and 6 ml/kg in sequence, and 15 min stabilization period for individual VT. The velocity time integral (VTI) of L-R shunt, pulmonary artery (PA) and descending aorta (DA) were measured with transesophageal echocardiography (TEE) after an initial 15 min stabilization period for each VT, with arterial blood gas analysis. Near-infrared spectroscopy sensor were positioned on the surface of the bilateral temporal artery to monitor the change in regional cerebral oxygen saturation (rScO2). Results PaCO2 was 31.51 ± 0.65 mmHg at VT 10 ml/kg vs. 37.15 ± 0.75 mmHg at VT 8 ml/kg (P < 0.03), with 44.24 ± 0.99 mmHg at VT 6 ml/kg significantly higher than 37.15 ± 0.75 mmHg at VT 8 ml/kg. However, PaO2 at a VT of 6 ml/kg was lower than that at a VT of 10 ml/kg (P = 0.05). Meanwhile, 72% (22/31) patients had PaCO2 in the range of 40-50 mmHg at VT 6 ml/kg. VTI of L-R shunt and PA at VT 6 ml/kg were lower than that at VT of 8 and 10 ml/kg (P < 0.05). rScO2 at a VT of 6 ml/kg was higher than that at a VT of 8 and 10 ml/kg (P < 0.05), with a significantly correlation between rScO2 and PaCO2 (r = 0.53). VTI of PA in patients with defect diameter > 10 mm was higher that that in patients with defect diameter ≤ 10 mm. Conclusions Maintaining PaCO2 in the boundary of 40-50 mmHg with VT 6 ml/kg might be a feasible ventilation regime to achieve better oxygenation for patients with L-R shunt. Continue raising PaCO2 should be careful. Trail registration Clinical Trial Registry of China (http://www.chictr.org.cn) identifier: ChiCTR-OOC-17011338, prospectively registered on May 9, 2017.

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Section: Introductionmentioning

confidence: 99%

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

Zeng

Wei

et al. 2019

BMC Anesthesiol

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“…Two anti-inflammatory markers were investigated (IL-10, SOD). Two studies found that IL-10 will either increase or decrease in BALF during OLV depending on the type of anaesthetic used ( 9 , 18 ), and three studies finding a decrease or no significant change ( 17 , 26 , 28 ).…”

Section: Resultsmentioning

confidence: 99%

“…These risk factors include high tidal volume (Vt), high airway pressures and high fraction of inspired oxygen (FiO 2 ) all of which can contribute to lung parenchyma stress and mechanical injury that induces inflammation (7). Common pro-inflammatory cytokines, such as TNFα and IL-6, are increased in patients that have undergone OLV, while anti-inflammatory cytokines like IL-10 are decreased in abundance (8)(9)(10). Based on current knowledge and understanding, we hypothesize that patients undergoing OLV are at greater risk for VILI compared to patients undergoing TLV for two major reasons: (I) OLV is primarily used in a population that already has pre-existing lung damage; and (II) in OLV, all the potentially injurious factors are exerted on one lung rather than being distributed between two lungs.…”

Section: Review Articlementioning

confidence: 99%

Identifying biomarkers of ventilator induced lung injury during one-lung ventilation surgery: a scoping review

et al. 2022

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Background: Ventilator-induced lung injury (VILI) can occur as a result of mechanical ventilation to two lungs. Thoracic surgery often requires one-lung ventilation (OLV). The potential for VILI is likely higher in OLV. The impact of OLV on development of post-operative pulmonary complications is not well understood. We aimed to perform a scoping review to determine reliable biomarkers of VILI after OLV.Methods: A scoping review was performed using Cochrane Collaboration methodology. We searched Medline, EMBASE and SCOPUS. Gray literature was searched. Studies of adult human or animal models without pre-existing lung damage exposed to OLV, with biomarker responses analyzed were included.Results: After screening 5,613 eligible papers, 89 papers were chosen for full text review, with 29 meeting inclusion. Approximately half (52%, n=15) of studies were conducted in humans in an intra-operative setting.Bronchoalveolar lavage (BAL) & serum analyses with ELISA-based assays were most commonly used. The majority of analytes were investigated by a single study. Of the analytes that were investigated by two or more studies (n=31), only 16 were concordant in their findings. Across all sample types and studies 84% (n=66) of the 79 inflammatory markers and 75% (n=6) of the 8 anti-inflammatory markers tested were found to increase. Half (48%) of all studies showed an increase in TNF-α or IL-6.Conclusions: A scoping review of the state of the evidence demonstrated that candidate biomarkers with the most evidence and greatest reliability are general markers of inflammation, such as IL-6 and TNF-α assessed using ELISA assays. Studies were limited in the number of biomarkers measured concurrently, sample size, and studies using human participants. In conclusion these identified markers can potentially serve as outcome measures for studies on OLV.

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“…Increased levels of cytokines including TNF-α, IL-6, and IL-10 have been observed in patients with coronary artery disease, and the use of high tidal volume (Vt) mechanical ventilation after lung cancer surgery can result in cytokine-mediated pneumonitis. Therefore, postoperative patients should receive ventilation with a reduced Vt and positive end-expiratory pressure (PEEP) to minimize the duration of mechanical ventilation, thereby preventing lung injury and reducing the risk of infection [103]. Excessive fluid infusion during the perioperative period may lead to postoperative pulmonary edema and other pulmonary injuries.…”

Section: Postoperative Management Of Patientsmentioning

confidence: 99%

A Review of Advances in the Surgical Treatment of Coronary Heart Disease and Lung Cancer

Hong,

Wei,

Tang

et al. 2023

HSF

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Lung cancer is currently the most prevalent and fatal malignant tumor in China. Additionally, the incidence of coronary heart disease is steadily increasing. Both diseases exhibit a higher risk of mortality with age, particularly among elderly patients. Moreover, these diseases are interconnected and share common risk factors. However, the treatment options for patients suffering from both lung cancer and coronary heart disease lack clarity and standardized criteria. This article critically examines the literature on surgical interventions for patients with lung cancer complicated by coronary artery disease during the period from January 2021 to December 2022. It summarizes the safety and effectiveness of these interventions and highlights the various surgical options available for different patient profiles.

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Effect of lung protective ventilation on coronary heart disease patients undergoing lung cancer resection

Abstract: LPV can effectively reduce the airway pressure, improve Cdyn and PaO, reduce concentrations of IL-6 and CRP during lung resection of CHD patients. The trial was registered in the Chinese Clinical Trial Registry.

Cited by 4 publications

References 50 publications

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

The effects of ventilation on left-to-right shunt and regional cerebral oxygen saturation: a self-controlled trial

Identifying biomarkers of ventilator induced lung injury during one-lung ventilation surgery: a scoping review

A Review of Advances in the Surgical Treatment of Coronary Heart Disease and Lung Cancer

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