Oxygenation and hemodynamic changes during one-lung ventilation: Effects of CPAP10, PEEP10, and CPAP10/PEEP10

Cohen, Edmond; Eisenkraft, James B.; Thys, Daniel M.; Kirschner, Paul A.; Kaplan, Joel A.

doi:10.1016/0888-6296(88)90145-7

Cited by 63 publications

(28 citation statements)

References 25 publications

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“…The cerebral oximeter employs an algorithm that assumes a 70% contribution from the venous blood such that an increased cerebral venous blood volume could potentially account for the desaturation signal seen. Nonetheless, in their study in dogs, Cohen et al 16 did not find an increase in central venous pressure with OLV. More recent work indicates an inverse correlation between stroke volume variability and right ventricular diastolic volume index.…”

Section: Discussionmentioning

confidence: 75%

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Brinkman

Amadeo

Funk

et al. 2013

Can J Anesth/J Can Anesth

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Purpose Cerebral desaturation occurs frequently in patients undergoing one-lung ventilation for thoracic surgery. The mechanism of this desaturation is unclear regarding its etiology. The objective of this study was to investigate whether or not decreases in cerebral oxygen saturation associated with one-lung ventilation were a consequence of decreased cardiac output. Methods A blinded observational study was conducted in 23 patients undergoing one-lung ventilation with thoracic surgery. Eighteen patients completed the study. Cerebral oxygen saturation was monitored using near-infrared spectroscopy (FORE-SIGHT Ò monitor). Invasive blood pressure was monitored and hemodynamic variables were interrogated using the FloTrac Ò system. Anesthesia was maintained with sevoflurane with a F I O 2 of 1.0. Post-hoc analysis involved a comparison between baseline and integrated changes in cerebral saturation, heart rate, stroke index, cardiac index, and stroke volume variability. Results All patients showed cerebral desaturation from a baseline of two-lung ventilation in the lateral decubitus position following institution of one-lung ventilation. The cardiac index was stable at these times, but with one-lung ventilation, the heart rate decreased and the stroke index increased to maintain a stable product. The integral of heart rate 9 time was inversely correlated with the integral of cerebral desaturation 9 time (linear regression analysis; P = 0.02; (df) = 16)). Conclusions Cerebral oxygen desaturation was universal during one-lung ventilation in this study. There was no correlation between cerebral desaturation and cardiac output or other hemodynamic variables.

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Section: Discussionmentioning

confidence: 75%

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Brinkman

Amadeo

Funk

et al. 2013

Can J Anesth/J Can Anesth

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“…Applying PEEP would help to splint the alveoli throughout the respiratory cycle and thus improve oxygenation. However, several studies on the effects of PEEP during OLV produced conflicting evidence, some showing improvement [12][13][14][15][16] and others no benefit or worsening of P a O 2 [17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

The effect of positive end expiratory pressure on the respiratory profile during one‐lung ventilation for thoracotomy*

2006

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Summary In this randomised controlled trial we examined the effects of four different levels of positive end expiratory pressure (PEEP at 0, 5, 8 or 10 cmH2O), added to the dependent lung, on respiratory profile and oxygenation during one lung ventilation. Forty‐six patients were recruited to receive one of the randomised PEEP levels during one lung ventilation. We did not find significant differences in lung compliance, intra‐operative or postoperative oxygenation amongst the four different groups. However, the physiological deadspace to tidal volume ventilation ratio was significantly lower in the 8 cmH2O PEEP group compared with the other levels of PEEP (p < 0.0001). We concluded that the use of PEEP (≤10 cmH2O) during one lung ventilation does not clinically improve lung compliance, intra‐operative or postoperative oxygenation despite a statistically significant reduction in the physiological deadspace to tidal volume ratio.

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“…The global effects of PEEP to the dependent lung thus represent the trade-off between these two opposing effects. It is therefore not surprising that some studies have shown PEEP to improve oxygenation during unilateral ventilation 34 , while others have shown no improvement or even worsening of oxygenation 38, 39 .…”

Section: Case I: Lung Resection In a Patient With Copdmentioning

confidence: 99%

“…CPAP may also interfere with surgical exposure. Some authors have combined the application of PEEP to the dependent lung and CPAP to the nondependent lung, although it is controversial whether this strategy offers any advantages compared to PEEP or CPAP alone 34, 39 . As a mitigating maneuver, intermittent insufflation of oxygen at low pressure into the conducting airways of the operative lung may provide enough apneic oxygenation to allow surgery to continue without compromising surgical exposure.…”

Section: Case I: Lung Resection In a Patient With Copdmentioning

confidence: 99%

Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

Melo

Musch

Kaczka

2012

Anesthesiology Clinics

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The induction and maintenance of anesthesia, surgical requirements, and patients’ unique pathophysiology all combine to create a setting in which our accumulated knowledge of respiratory physiology and lung mechanics take on immediate and central importance in patient management. In this review we will take a case-based approach to illustrate how the complex interactions between anesthesia, surgery, and patient disease impact patient care with respect to pulmonary pathophysiology and clinical decision-making. We will examine two disparate scenarios: a patient with chronic obstructive pulmonary disease undergoing a lung resection, and a patient with coronary artery disease undergoing cardiopulmonary bypass. In each example we will illustrate how important concepts in pulmonary physiology and respiratory mechanics impact clinical management decisions.

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Oxygenation and hemodynamic changes during one-lung ventilation: Effects of CPAP10, PEEP10, and CPAP10/PEEP10

Cited by 63 publications

References 25 publications

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

Cerebral oxygen desaturation during one-lung ventilation: correlation with hemodynamic variables

The effect of positive end expiratory pressure on the respiratory profile during one‐lung ventilation for thoracotomy*

Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

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