Setting Individualized Positive End-Expiratory Pressure Level with a Positive End-Expiratory Pressure Decrement Trial After a Recruitment Maneuver Improves Oxygenation and Lung Mechanics During One-Lung Ventilation

Abstract

During one-lung ventilation, the improvements in oxygenation and lung mechanics after an alveolar recruitment maneuver were better preserved by ventilation by using individualized PEEP with a PEEP decrement trial than with a standardized 5 cm·H2O of PEEP.

Combination of Continuous Positive Airway Pressure and Air Reinflation during One-Lung Ventilation Attenuates Lung Injury Following Esophagectomy: A Randomized Clinical Trial

“…A current proposal for lung injury takes the view that injury is induced by a "multiple-hit" mechanism (25). Mechanical ventilation during esophagectomy (including OLV) and surgical manipulation bring about the first hit (1), and reinflation may result in the second hit.…”

“…The probable causes may be related to the limited protective effect of air reinflation, including almost ASA I-II patients, and the sample size calculation. During the first hit interval, other therapeutic measures such as reduction of VT combined with positive end-expiratory pressure (PEEP) and lower FiO2 have also been reported to be protective (6,25). And the application of CPAP allows the use of lower FiO2 without compromising intraoperative oxygenation.…”

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

“…3 Ferrando et al recently showed improved oxygenation and lung mechanics when external PEEP was set based on achieving optimal dynamic lung compliance using a PEEP decrement trial after a lung recruitment maneuver. 32 …”

“…ont récemment montré une amélioration de l'oxygénation et de la mécanique pulmonaire lorsqu'après l'application d'une MRA, la PEEP était progressivement réduite afin d'atteindre la compliance pulmonaire dynamique optimale. 32 Recommandations…”

Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

“…We suggest using higher PEEP levels than the ones typically recommended for OLV (0-5 cm H 2 O). In a recent study, Ferrando et al [72] have determined in 15 patients that the optimum PEEP after a RM for OLV varies from 6 to 12 cm H 2 O (mean 10 ± 2 cm H 2 O). These personalized levels of PEEP improved arterial oxygenation and decreased dead space compared to patients receiving a RM but only 5 cm H 2 O of PEEP.…”