Patterns of Changes in Arterial PO2 During One-Lung Ventilation: A Comparison Between Patients With Severe Pulmonary Emphysema and Patients With Preserved Lung Function

Aschkenasy, Schlomo V.; Hofer, Christoph K.; Zaugg, Michael; Weder, Walter; Seifert, Burkhardt; Pasch, Thomas; Zollinger, Andreas

doi:10.1053/j.jvca.2005.05.005

Cited by 13 publications

(7 citation statements)

References 28 publications

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“… 23 , 25 , 26 However, there is controversy in the literature regarding the results of some studies which have claimed significantly higher PaO 2 /F i O 2 ratios than we found. 27 Furthermore, there is a continuing dispute over intrinsic PEEP and oxygenation during OLV in COPD patients. Although Bardoczky et al, 26 assert that intrinsic PEEP and oxygenation have a negative correlation, other views have been expressed by, for example, Aschkenasy et al , 27 who stated that intrinsic PEEP may delay events of hypoxaemia in severe COPD patients when compared with healthy patients.…”

Section: Discussionmentioning

confidence: 99%

“… 27 Furthermore, there is a continuing dispute over intrinsic PEEP and oxygenation during OLV in COPD patients. Although Bardoczky et al, 26 assert that intrinsic PEEP and oxygenation have a negative correlation, other views have been expressed by, for example, Aschkenasy et al , 27 who stated that intrinsic PEEP may delay events of hypoxaemia in severe COPD patients when compared with healthy patients. Some authors have explained that intrinsic PEEP caused by the hyperinflation of ventilated lungs in patients with severe COPD increases the functional residual capacity and improves oxygenation during OLV.…”

Section: Discussionmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

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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“…One-lung ventilation during thoracotomy followed the principles of a lung protective strategy, using pressure-limited or pressure-controlled ventilation modes with tidal volumes of <7 ml/kg body weight, positive end-expiratory pressure of 3-5 cm H2O and limiting peak inspiratory pressures to <30 cm H2O. Inspired oxygen concentration on the ventilated lung was set to 100% at the beginning and gradually reduced thereafter based on the arterial oxygen tension measured by repeated blood gas analyses [13-15]. Continuous monitoring included ECG analysis, measurement of arterial oxygen saturation with pulse oxymetry and invasive arterial as well as central venous pressure monitoring.…”

Section: Methodsmentioning

confidence: 99%

Cytokine & chemokine response in the lungs, pleural fluid and serum in thoracic surgery using one-lung ventilation

et al. 2011

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BackgroundThoracic surgery mandates usually a one-lung ventilation (OLV) strategy with the collapse of the operated lung and ventilation of the non-operated lung. These procedures trigger a substantial inflammatory response. The aim of this study was to analyze the cytokine and chemokine reaction in both lungs, pleural space and blood in patients undergoing lung resection with OLV with special interest in the chemokine growth-regulated peptide alpha (GROα) which is the human equivalent to the rat cytokine-induced neutrophil chemoattractant-1 (CINC-1).MethodsBroncho-alveolar lavage (BAL) fluid of both the collapsed, operated and the ventilated, non-operated lung, respectively, pleural space drainage fluid and blood was collected and the concentrations of interleukin (IL)-6, IL-1RA and GROα were determined with enzyme-linked immunosorbent assays in 15 patients.ResultsSubstantial inter-individual differences in the BAL fluid between patients in cytokine and chemokine levels occurred. In the pleural fluid and the blood these inter-individual differences were less pronounced. Both sides of the lung were affected and showed a significant increase in IL-6 and IL-1RA concentrations over time but not in GROα concentrations. Except for IL-6, which increased more in the collapsed, operated lung, no difference between the collapsed, operated and the ventilated, non-operated lung occurred. In the blood, IL-6 and IL-1RA increased early, already at the end of surgery. GROα was not detectable. In the pleural fluid, both cytokine and chemokine concentrations increased by day one. The increase was significantly higher in the pleural fluid compared to the blood.ConclusionThe inflammatory response of cytokines affects both the collapsed, operated and the ventilated, non-operated lungs. The difference in extent of response underlines the complexity of the inflammatory processes during OLV. In contrast to the cytokines, the chemokine GROα concentrations did not react in the BAL fluid or in the blood. This indicates that GROα might not be useful as marker for the inflammatory reaction in complex surgical procedures.

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“…There have been several reports, which have shown that in one-lung ventilation there is ventilation-perfusion mismatch in the dependent, ventilated lung which is prone to collapse during expiration which can induce hypoxemia [1][2][3]. Most studies have focused on changes in hemodynamics or respiratory mechanics of the dependent lung.…”

Section: Introductionmentioning

confidence: 99%

Histochemical Alterations in One Lung Ventilation

Yin¹,

Gribbin²,

Emanuel³

et al. 2007

Journal of Surgical Research

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Patterns of Changes in Arterial PO2 During One-Lung Ventilation: A Comparison Between Patients With Severe Pulmonary Emphysema and Patients With Preserved Lung Function

Cited by 13 publications

References 28 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

Cytokine & chemokine response in the lungs, pleural fluid and serum in thoracic surgery using one-lung ventilation

Histochemical Alterations in One Lung Ventilation

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