Gravity is an important determinant of oxygenation during one‐lung ventilation

Szegedi, László; D’Hollander, Alain; Vermassen, Frank; Deryck, F.; Wouters, Patrick

doi:10.1111/j.1399-6576.2010.02238.x

Cited by 21 publications

(17 citation statements)

References 17 publications

(22 reference statements)

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“… 6 , 7 One-lung ventilation (OLV) aggravates the intrapulmonary shunt and dead space, whereas gravitational effects and hypoxic pulmonary vasoconstriction (HPV) act as protective mechanisms. 8 , 9 However, decreased pulmonary artery compliance and increased pulmonary artery stiffness are reported in early COPD without pulmonary hypertension, 10 , 11 and the HPV responses have been reported to be less efficient in patients with COPD. 12 Furthermore, the treatment strategies for hypoxaemia induced by OLV, such as positive end-expiratory pressure (PEEP) and alveolar recruitment, cannot be applied to COPD patients because of concern about high intrinsic PEEP development.…”

Section: Introductionmentioning

confidence: 99%

Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery

Lee

Kim

Lee

et al. 2016

European Journal of Anaesthesiology

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BACKGROUNDChronic obstructive pulmonary disease (COPD) is a risk factor that increases the incidence of postoperative cardiopulmonary morbidity and mortality after lung resection. Dexmedetomidine, a selective α2-adrenoreceptor agonist, has been reported previously to attenuate intrapulmonary shunt during one-lung ventilation (OLV) and to alleviate bronchoconstriction.OBJECTIVEThe objective is to determine whether dexmedetomidine improves oxygenation and lung mechanics in patients with moderate COPD during lung cancer surgery.DESIGNA randomised, double-blinded, placebo-controlled study.SETTINGSingle university hospital.PARTICIPANTSFifty patients scheduled for video-assisted thoracoscopic surgery who had moderate COPD. Patients were randomly allocated to a control group or a Dex group (n = 25 each).INTERVENTIONSIn the Dex group, dexmedetomidine was given as an initial loading dose of 1.0 μg kg−1 over 10 min followed by a maintenance dose of 0.5 μg kg−1 h−1 during OLV while the control group was administered a comparable volume of 0.9% saline. Data were measured at 30 min (DEX-30) and 60 min (DEX-60) after dexmedetomidine or saline administration during OLV.MAIN OUTCOME MEASURESThe primary outcome was the effect of dexmedetomidine on oxygenation. The secondary outcome was the effect of dexmedetomidine administration on postoperative pulmonary complications.RESULTSPatients in the Dex group had a significantly higher PaO2/FiO2 ratio (27.9 ± 5.8 vs. 22.5 ± 8.4 and 28.6 ± 5.9 vs. 21.0 ± 9.9 kPa, P < 0.05), significantly lower dead space ventilation (19.2 ± 8.5 vs. 24.1 ± 8.1 and 19.6 ± 6.7 vs. 25.3 ± 7.8%, P < 0.05) and higher dynamic compliance at DEX-30 and DEX-60 (P = 0.0001 and P = 0.0184) compared with the control group. In the Dex group, the PaO2/FiO2 ratio in the postoperative period was significantly higher (P = 0.022) and the incidence of ICU admission was lower than in the control group.CONCLUSIONDexmedetomidine administration may provide clinically relevant benefits by improving oxygenation and lung mechanics in patients with moderate COPD undergoing lung cancer surgery.TRIAL REGISTRATIONClinicalTrial.gov identifier: NCT 02185430.

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Section: Introductionmentioning

confidence: 99%

Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery

Lee

Kim

Lee

et al. 2016

European Journal of Anaesthesiology

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“…Compared with two-lung ventilation (TLV), an increase in peak airway pressure of ~55% occurs during OLV (34,35). Szegedi et al (36) firstly demonstrated that the effect of gravity on V/Q matching, independent of HPV, resulted in more severe oxidative stress on the operated lung. Misthos et al (37) reported that reactivation of the collapsed lung can activate severe oxidative stress, which was correlated with the time of OLV by reviewing 212 cases between 2001 and 2003 of lung injury caused by re-expansion and reperfusion.…”

Section: Discussionmentioning

confidence: 99%

Protective effect of nicorandil on collapse‑induced lung injury in rabbits by inhibiting apoptosis

Wang

et al. 2019

Int J Mol Med

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The one-lung ventilation (OLV) technique is vital in thoracic surgery. However, it can result in severe lung injury, which is difficult to manage. The main solution at present is the use of ventilation strategies, including continuous positive oxygen pressure, low tidal volume and high frequency ventilation, and the administering of drugs, including phenylephrine, dexmedetomidine and morphine. However, the protective effect of these methods on the lungs is not sufficient to improve the prognosis of patients. Therefore, how to develop a novel protective drug remains an open question. Nicorandil, a mitochondrial (mito)KATP-specific opener, serves an important role in cardioprotection, although its effect on lung injury remains unclear. The present study examined the protective role of nicorandil against collapse-induced lung injury in rabbits undergoing OLV. changes in arterial oxygen saturation (SaO 2), arterial partial pressure for oxygen (PaO 2), wet/dry weight ratio, and the microstructure of tissues and cells were observed. Enzyme-linked immunosorbent assays were used to determine the concentrations of malondialdehyde (MDA) and tumor necrosis factor (TNF)-α, and the activity of superoxide dismutase (SOD) in rabbits treated with nicorandil. Terminal deoxynucleotidyl transferase transfer-mediated dUTP nick end-labeling was used to detect apoptosis and western blotting was used to analyze the relative proteins involved in apoptosis. Western blotting and reverse transcription-quantitative polymerase chain reaction analysis were used to examine the expression of hypoxia inducible factor 1α (HIF-1α), phosphatidylinositol-3-kinase (PI3K), protein kinase B (Akt) and nuclear factor (NF)-κB in the lungs of rabbits treated with nicorandil. The SaO 2 and PaO 2 in the high-dose group were significantly higher than those in the control group in the process of OLV. The wet/dry weight ratio, and the concentrations of MdA and TNF-α in the collapsed lung of the high-dose group were significantly lower than those in the control group. The activity of SOD in the high-dose group was significantly higher than that in the control group. The lung had improved microstructure and less apoptosis, which was determined by the Bax/Bcl2 ratio in the high-dose group. The expression levels of PI3K, phosphorylated Akt and HIF-1α were upregulated, whereas the expression of NF-κB was downregulated. In conclusion, nicorandil had a protective effect via inhibiting apoptosis in non-ventilated lung collapsed and re-expansion during OLV in the rabbit. It acted on mitoKATP through the PI3K/Akt signaling pathway.

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“…Several clinical studies and reviews have described the influence of gravity on oxygenation and pulmonary blood flow distribution during OLV. [11][12][13][14] In a recent study, Lee et al 12 assessed the pulmonary venous flow using TEE and demonstrated that the lateral decubitus position itself increased the pulmonary blood flow of the dependent lung via the gravitational effect. The pulmonary blood flow increased 10 minutes after the body position change from supine to a lateral decubitus position.…”

Section: Discussionmentioning

confidence: 99%

Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery

Suga

Kobayashi

Ochiai

2017

Journal of Cardiothoracic and Vascular Anesthesia

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Gravity is an important determinant of oxygenation during one‐lung ventilation

Cited by 21 publications

References 17 publications

Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery

Effects of dexmedetomidine on oxygenation and lung mechanics in patients with moderate chronic obstructive pulmonary disease undergoing lung cancer surgery

Protective effect of nicorandil on collapse‑induced lung injury in rabbits by inhibiting apoptosis

Impact of Left Heart Bypass on Arterial Oxygenation During One-Lung Ventilation for Thoracic Aortic Surgery

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