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

Abstract

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).

Effect of Dexmedetomidine on Oxygen and Intrapulmonary Shunt (Qs/Qt) During One-Lung Ventilation in Pediatric Surgery: A Randomized Controlled Trial

“…Janković et al, in 2019, mentioned that OLV carries a risk of hypoxia and hypercapnia due to intrapulmonary shunting and dead space ventilation [46]. Both can significantly impact the management of perioperative anesthesia and postoperative complications.…”

“…However, preventative ventilation appears appropriate to lower the risk of lung damage and acute lung injury (ALI), although no published guidelines exist. Despite a growing awareness of the importance of preventive ventilation, many clinicians still use running volume and maximum pressure outside the recommended levels in daily practice [46].…”

“…Here, the importance of using dexmedetomidine appears to be significantly reduced in reducing the need for high pressures used during mechanical ventilation to ensure adequate oxygenation, as the P peak value recorded in our study decreased in the group of patients who received dexmedetomidine during the operation. As for the second group that did not apply dexmedetomidine, we had to increase the pressure (P peak), according to Janković et al [46]. Bai et al [47] and Wu et al [48] showed that dexmedetomidine reduces the inflammatory response during lung ventilation, thereby reducing lung injury.…”