Gradient of bronchial end-tidal CO2 during two-lung ventilation in lateral decubitus position is predictive of oxygenation disorder during subsequent one-lung ventilation

Yamamoto, Yosuke; Watanabe, Seiji; Kano, Tatsuhiko

doi:10.1007/s00540-008-0737-9

Cited by 9 publications

(5 citation statements)

References 17 publications

(28 reference statements)

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“…Yamamoto et al . [ 6 ] found a moderate correlation between D-EtCO 2lateral and oxygenation at 15 min during OLV in 18 patients undergoing lung surgeries. Our study tested the correlation over a longer period of time during OLV by involving a larger sample population and tested the predictive ability of D-EtCO 2 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The utility of gradient of end-tidal carbon dioxide between two lungs in lateral decubitus position in predicting a drop in oxygenation during one-lung ventilation in elective thoracic surgery- A prospective observational study

Parab¹,

Chatterjee²,

Saxena³

2021

Indian J Anaesth

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Background and Aims: Baseline difference in the perfusion of two lungs is the cause of intra-operative shunt during one-lung ventilation (OLV). This study aimed to test the hypothesis that the gradient of end-tidal carbon dioxide (EtCO 2 ) between two lungs in lateral position (D-EtCO 2lateral ) would predict the quantity of shunt and hence the drop in the oxygenation during OLV. Methods: An observational study was conducted to include consecutive 70 patients undergoing thoracic surgery using a double-lumen tube in a lateral position. D-EtCO 2lateral was calculated by subtracting EtCO 2 from the non-dependent lung from that of the dependent lung when ventilation parameters are the same for each lung. Oxygenation was assessed by measuring PaO 2 /FiO 2 ratios (P/F ratio) at 10, 20 and 40 min after OLV. Correlations between D-EtCO 2lateral and P/F ratios were calculated. Receiver operating curves were analysed to test the ability of D-EtCO 2lateral to identify patients with a P/F ratio of <100 during OLV. Results: A moderate correlation was found between D-EtCO 2lateral and P/F ratios at 10 and 20 min of OLV. Among lung resection cases (n = 61), correlation was moderate at 10 (r = 0.64), and 20 min (r = 0.65) ( P < 0.001) and became weak at 40 min (r = 0.489, P < 0.001). Areas under curve for D-EtCO 2lateral to predict the drop in P/F ratio <100 at 10, 20 and 40 min after OLV were 0.90 (cut-off: 2.5), 0.78 (cut-off: 3.5) and 0.78 (cut-off: 4.5), respectively. Conclusion: D-EtCO 2lateral could predict the drop in oxygenation in the early part of OLV in lung resection surgeries.

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Section: Discussionmentioning

confidence: 99%

“…Yamamoto et al . [ 6 ] found a moderate correlation (r = 0.69, P < 0.01) between D-EtCO 2 and P/F ratio at 15 min after OLV in 18 patients undergoing lung surgery. Hence, considering the non-interventional design of the study and to test correlation in the later part of OLV, we chose the sample size as 70 patients.…”

Section: Methodsmentioning

confidence: 99%

The utility of gradient of end-tidal carbon dioxide between two lungs in lateral decubitus position in predicting a drop in oxygenation during one-lung ventilation in elective thoracic surgery- A prospective observational study

Parab¹,

Chatterjee²,

Saxena³

2021

Indian J Anaesth

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“…64,65 Two recent studies presented by Fukuoka et al and Yamamoto et al found a significant linear relationship between ETCO 2 and the PaO 2 /FiO 2 ratio af-ter starting OLV, as ETO 2 depends on perfusion, it can be predictable parameter OLV hypoxemia occurance. 61,66 Tissue oxygenation At present, cerebral oximetry is the only noninvasive monitor available to determine tissue oxygenation during OLV. Decreased levels of cerebral tissue oxygen saturation obtained by noninvasive cerebral oxygen monitoring were found in the majority of patients during OLV.…”

Section: Prediction Of Hypoxemia Capnometrymentioning

confidence: 99%

Intraoperative hypoxemia during one-lung ventilation: Is it still an anesthesiologists' nightmare? (hypoxemia during one-lung ventilation)

Janković¹,

Stojanović²,

Vuković³

et al. 2019

Serb J Anest Inten Therapy

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Ventilacija jednog plućnog krila se koristi iz različitih hirurških i ne-hirurških razloga. Ovaj tip ventilacije nosi sa sobom određene rizike za razvoj ventilaciono/perfuzionih poremećaja različitog stepena povezanim sa lateralnim dekubitalnim položajem, jednostranom plućnom ventilacijom i otvaranjem grudnog koša. Kako je hipoksemija jedna od posledica jednostrane plućne ventilacije, različite strategije ventilacije se preporučuju u cilju njene prevencije i lečenja. Strategija uključuje određene manevre na ventilišućem i ne-ventilišućem plućnom krilu kao i upotrebu određenih lekova koji mogu modulirati i intenzivirati fenomen jedinstven za plućnu cirkulaciju-hipoksičnu plućnu vazokontrikciju (HPV). Ključne reči: hipoksemija, jednostrana ventilacija pluća, hipoksična plućna vazokonstrikcija Sumarry Lung isolation is used for various surgical and non-surgical reasons. This type of ventilation carries the risk for various degrees of ventilation/perfusion mismatch associated with lateral decubitus position, one-lung ventilation (OLV) and opened chest. According to this, hypoxemia is common consequence of OLV. Among various recommended ventilation strategies in order to prevent hypoxemia, protective ventilation with lower tidal volumes and applied positive end-expiratory (PEEP) pressure give some promising results. Adequate treatment and possibility to predict hypoxemia during OLV is very important for reducing morbidity and mortality. Treatment includes ventilator strategies on both, ventilated and non-ventilated lung and applied therapy, which can influence and modulate the magnitude of phenomenon unique for lung circulation-hypoxic pulmonary vasoconstriction (HPV).

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“…Otra de las causas frecuentes de hipercapnia es el agotamiento del absorbente de CO2 o disminución del aire fresco con la consiguiente reinhalación de CO2 (23) . Se ha encontrado también hipercapnia en las técnicas de ventilación unipulmonar en pacientes con neumopatía crónica (31) ; y otras causas más raras son estados hipermetabólicos como la Hipertermia Maligna, que es un síndrome farmacogenético que puede llegar a ser fatal, relacionado con la administración de anestésicos inhalatorios o relajantes musculares despolarizantes en pacientes con mutación del gen rianodina y el gen CACNA1S (voltage-dependent L type calcium channel alpha 1S subunit), responsable de la regulación de canales de calcio en el musculo esquelético humano, cuyo signo de presentación más temprano es una elevación no explicada de la presión parcial de CO2 espirado (32) .…”

Section: Factores De Riesgo De Complicaciones Postoperatorias Pulmonaresunclassified

CARDIAC ARREST IN A POSTOPERATIVE CARE UNIT. LITERATURE REVIEW OF PULMONARY PERIOPERATIVE CRITICAL SITUATIONS - Paro cardiaco en unidad de cuidado postoperatorio. Revisión de la literaturade situaciones críticas pulmonares preoperatorias.

Samaca¹,

Cogollo²,

Gamba³

et al. 2018

JOSHA

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Gradient of bronchial end-tidal CO2 during two-lung ventilation in lateral decubitus position is predictive of oxygenation disorder during subsequent one-lung ventilation

Abstract: The D-ETbr(CO2) predetermined during TLV in LP could be a predictive factor for the severity of oxygenation disorder after starting OLV in LP.

Cited by 9 publications

References 17 publications

The utility of gradient of end-tidal carbon dioxide between two lungs in lateral decubitus position in predicting a drop in oxygenation during one-lung ventilation in elective thoracic surgery- A prospective observational study

The utility of gradient of end-tidal carbon dioxide between two lungs in lateral decubitus position in predicting a drop in oxygenation during one-lung ventilation in elective thoracic surgery- A prospective observational study

Intraoperative hypoxemia during one-lung ventilation: Is it still an anesthesiologists' nightmare? (hypoxemia during one-lung ventilation)

CARDIAC ARREST IN A POSTOPERATIVE CARE UNIT. LITERATURE REVIEW OF PULMONARY PERIOPERATIVE CRITICAL SITUATIONS - Paro cardiaco en unidad de cuidado postoperatorio. Revisión de la literaturade situaciones críticas pulmonares preoperatorias.

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