Effects of head-down tilt on intrapulmonary shunt fraction and oxygenation during one-lung ventilation in the lateral decubitus position

Choi, Yong Seon; Bang, Sou Ouk; Shim, Jæ Kwang; Chung, Kwansoo; Kwak, Young Lan; Hong, Yong Woo

doi:10.1016/j.jtcvs.2007.05.018

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…Many studies have shown that a decrease in flow leads to a preferential increase in the perfusion of the normoxic (ventilated) lung, and the magnitude of HPV is flowdependent in the hypoxic lung region [16,17]. In our study, the values of CO stayed in a similar range in the two groups throughout the entire experiment, which meant that intravenous HOS had no significant influence on CO during OLV.…”

Section: Discussionsupporting

confidence: 46%

The Effects of Intravenous Hyperoxygenated Solution Infusion on Systemic Oxygenation and Intrapulmonary Shunt During One-Lung Ventilation in Pigs

Gao

Zhang

Sun

et al. 2010

Journal of Surgical Research

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Section: Discussionsupporting

confidence: 46%

The Effects of Intravenous Hyperoxygenated Solution Infusion on Systemic Oxygenation and Intrapulmonary Shunt During One-Lung Ventilation in Pigs

Gao

Zhang

Sun

et al. 2010

Journal of Surgical Research

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“…However, Mitlyng et al had identified a similar 25% shorter RBC lifespan in patients with arthritis limiting mobility and with chronic anemia 75 . Therefore, low-grade hemolysis may be the mechanism explaining the high prevalence of anemia in patients who remain bedridden for prolonged durations [76][77][78][79][80] . In these patients, different approaches may be needed to address increased hemolysis with bed rest.…”

Section: Discussionmentioning

confidence: 99%

Six degrees head-down tilt bed rest caused low-grade hemolysis: a prospective randomized clinical trial

et al. 2021

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This study aimed to measure hemolysis before, during and after 60 days of the ground-based spaceflight analog bed rest and the effect of a nutritional intervention through a prospective randomized clinical trial. Twenty male participants were hospitalized for 88 days comprised of 14 days of ambulatory baseline, 60 days of 6° head-down tilt bed rest and 14 days of reambulation. Ten participants each received a control diet or daily polyphenol associated with omega-3, vitamin E, and selenium supplements. The primary outcome was endogenous carbon monoxide (CO) elimination measured by gas chromatography. Hemolysis was also measured with serial bilirubin, iron, transferrin saturation blood levels and serial 3-day stool collections were used to measure urobilinoid excretion using photometry. Total hemoglobin mass (tHb) was measured using CO-rebreathing. CO elimination increased after 5, 11, 30, and 57 days of bed rest: +289 ppb (95% CI 101–477 ppb; p = 0.004), +253 ppb (78–427 ppb; p = 0.007), +193 ppb (89–298 ppb; p = 0.001) and +858 ppb (670–1046 ppb; p < 0.000), respectively, compared to baseline. Bilirubin increased after 20 and 49 days of bed rest +0.8 mg/l (p = 0.013) and +1.1 mg/l (p = 0.012), respectively; and iron increased after 20 days of bed rest +10.5 µg/dl (p = 0.032). The nutritional intervention did not change CO elimination. THb was lower after 60 days of bed rest −0.9 g/kg (p = 0.001). Bed rest enhanced hemolysis as measured through all three by-products of heme oxygenase. Ongoing enhanced hemolysis over 60 days contributed to a 10% decrease in tHb mass. Modulation of red blood cell control towards increased hemolysis may be an important mechanism causing anemia in astronauts.

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“…Should these parameters not be met, oxygen delivery to the cells will be inadequate, leading to anaerobic metabolism and potential multi-organ failure. One of the reasons for clinical ventilation/perfusion mismatch can be pulmonary pathology, leading to so called shunt [ 1 – 3 ], another is—patient positioning on the operating table [ 4 , 5 ]. While young and healthy subjects can cope this scenario due to the efficiency of their physiological reflexes, in medicine, many surgical procedures involve elderly and critically ill patients with significant health impairments [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

et al. 2017

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IntroductionAdequate blood oxygenation and ventilation/perfusion matching should be main goal of anaesthetic and intensive care management. At present, one of the methods of improving gas exchange restricted by ventilation/perfusion mismatching is independent ventilation with two ventilators. Recently, however, a unique device has been developed, enabling ventilation of independent lungs in 1:1, 2:1, 3:1, and 5:1 proportions. The main goal of the study was to evaluate the device’s utility, precision and impact on pulmonary mechanics. Secondly- to measure the gas distribution in supine and lateral decubitus position.Materials and methods69 patients who underwent elective thoracic surgery were eligible for the study. During general anaesthesia, after double lumen tube intubation, the aforementioned control system was placed between the anaesthetic machine and the patient. In the supine and lateral decubitus (left/right) positions, measurements of conventional and independent (1:1 proportion) ventilation were performed separately for each lung, including the following: tidal volume, peak pressure and dynamic compliance.ResultsOur results show that conventional ventilation using Robertshaw tube in the supine position directs 47% of the tidal volume to the left lung and 53% to the right lung. Furthermore, in the left lateral position, 44% is directed to the dependent lung and 56% to the non-dependent lung. In the right lateral position, 49% is directed to the dependent lung and 51% to the non-dependent lung. The control system positively affected non-dependent and dependent lung ventilation by delivering equal tidal volumes into both lungs with no adverse effects, regardless of patient's position.ConclusionsWe report that gas distribution is uneven during conventional ventilation using Robertshaw tube in the supine and lateral decubitus positions. However, this recently released control system enables precise and safe independent ventilation in the supine and the left and right lateral decubitus positions.

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Effects of head-down tilt on intrapulmonary shunt fraction and oxygenation during one-lung ventilation in the lateral decubitus position

Abstract: Head-down tilt during one-lung ventilation in the lateral decubitus position caused a significant increase in shunt and a decrease in percent change of arterial oxygen tension, without causing dangerous hypoxemia.

Cited by 16 publications

References 25 publications

The Effects of Intravenous Hyperoxygenated Solution Infusion on Systemic Oxygenation and Intrapulmonary Shunt During One-Lung Ventilation in Pigs

The Effects of Intravenous Hyperoxygenated Solution Infusion on Systemic Oxygenation and Intrapulmonary Shunt During One-Lung Ventilation in Pigs

Six degrees head-down tilt bed rest caused low-grade hemolysis: a prospective randomized clinical trial

Successful 1:1 proportion ventilation with a unique device for independent lung ventilation using a double-lumen tube without complications in the supine and lateral decubitus positions. A pilot study

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