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

Brassard, C; Lohser, Jens; Donati, François; Bussières, Jean S.

doi:10.1007/s12630-014-0246-2

Cited by 55 publications

(39 citation statements)

References 56 publications

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“…One-lung ventilation (OLV) is a standard anesthesia practice that was widely used in lung cancer resection surgery. The ventilation of one side of the lung that cancerated was discontinued temporarily during OLV, resulting in a mismatch of ventilation-perfusion (V/Q) ratio and hypoxia [10]. Recently, it has been reported that hypoxia induced by a…”

Section: Introductionmentioning

confidence: 99%

Sevoflurane suppresses hypoxia-induced growth and metastasis of lung cancer cells via inhibiting hypoxia-inducible factor-1α

et al. 2015

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Section: Introductionmentioning

confidence: 99%

Sevoflurane suppresses hypoxia-induced growth and metastasis of lung cancer cells via inhibiting hypoxia-inducible factor-1α

et al. 2015

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“…The Qs/Qt ratio is approximately 2–5% in daily life and up to 10% after general anesthesia and lying on your side, but it can increase to 40–50% after OLV. [26] To date, it is uncertain whether there is well-established prophylaxis, although various preventive and protective measures have been studied, such as lung-protective ventilation strategies (lower tidal volumes and higher positive end-expiratory pressure)[27282930] and reducing the use of inhalation anesthetics. [31]…”

Section: Discussionmentioning

confidence: 99%

Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials

Huang

Zhang

et al. 2017

Chinese Medical Journal

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Background:One-lung ventilation (OLV) is a common ventilation technology during thoracic surgery that can cause serious clinical problems. We aimed to conduct a meta-analysis to compare oxygenation and intrapulmonary shunt during OLV in adults undergoing thoracic surgery with dexmedetomidine (Dex) versus placebo to assess the influence and safety of using Dex.Methods:Randomized controlled trials comparing lung protection in patients who underwent thoracic surgery with Dex or a placebo were retrieved from PubMed, EMBASE, MEDLINE, Cochrane Library, and China CNKI database. The following information was extracted from the paper: arterial oxygen partial pressure (PaO2), PaO2/inspired oxygen concentration (PaO2/FiO2, oxygenation index [OI]), intrapulmonary shunt (calculated as Qs/Qt), mean arterial pressure (MAP), heart rate (HR), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, superoxide dismutase (SOD), and malondialdehyde (MDA).Results:Fourteen randomized controlled trials were included containing a total of 625 patients. Compared with placebo group, Dex significantly increased PaO2/FiO2 (standard mean difference [SMD] = 0.98, 95% confidence interval [CI] [0.72, 1.23], P < 0.00001). Besides, Qs/Qt (SMD= −1.22, 95% CI [−2.20, −0.23], P = 0.020), HR (SMD= −0.69, 95% CI [−1.20, 0.17], P = 0.009), MAP (SMD= −0.44, 95% CI [−0.84, 0.04], P = 0.030), the concentrations of TNF-α (SMD = −1.55, 95% CI [−2.16, −0.95], P <0.001), and IL-6 (SMD = −1.53, 95% CI [−2.37, −0.70], P = 0.0003) were decreased in the treated group, when compared to placebo group. No significant difference was found in MDA (SMD = −1.14, 95% CI [−3.48, 1.20], P = 0.340) and SOD (SMD = 0.41, 95% CI [−0.29, 1.10], P = 0.250) between the Dex group and the placebo group. Funnel plots did not detect any significant publication bias.Conclusions:Dex may improve OI and reduce intrapulmonary shunt during OLV in adults undergoing thoracic surgery. However, this conclusion might be weakened by the limited number of pooled studies and patients.

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“…The tidal volume was set as 7 mL/kg (ideal body weight) during two-lung ventilation and 6 mL/kg (ideal body weight) during OLV, respectively. The respiratory rate was 12/min, and I:E ratio was 1:2 without positive end-expiratory pressure (PEEP) [9][10] .…”

Section: Methodsmentioning

confidence: 99%

Volume of Tidal Gas Movement in the Nonventilated Lung during One-lung Ventilation and its Relevant Factors

Wei

Gao

Sun

et al. 2020

Preprint

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Background: The passive ventilation of nonventilated lung results in tidal gas movement (TGM) and thus affects lung collapse. The present study aimed to measure the volume of TGM and to analyse the relevant factors of the TGM index (TGM/body surface area).Methods: One hundred eight patients scheduled for elective thoracoscopic surgeries were enrolled. Lung isolation was achieved with a double-lumen endobronchial tube (DLT). The paediatric spirometry sensor was connected to the double-lumen connector of the nonventilated lung to measure the volume of TGM during one-lung ventilation (OLV) in the lateral position. The TGM index was calculated. The multiple linear regression was analysed using the TGM index as the dependent variables. Independent variables were also recorded: 1) age, sex, body mass index (BMI); 2) forced vital capacity (FVC), FEV1/FVC, minute ventilation volume (MVV); 3) dynamic lung compliance (Cdyn) and peak inspiratory pressure (PIP) during dual lung ventilation; 4) the side of OLV; and 5) whether lung puncture for localization of the pulmonary nodule was performed on the day of surgery. The oxygen concentration in the nonventilated lung was measured at 5 min after OLV, and its correlation with the TGM index was analysed.Results: The volume of TGM in the nonventilated lung during OLV was 78 [37] mL. The TGM index was 45 [20] mL/m2 and was negatively correlated with the oxygen concentration in the nonventilated lung at 5 min after OLV. The multiple linear regression model for the TGM index was deduced as follows: TGM index (mL/m2)=C+12.770×a-3.987×b-1.237×c-2.664×d, where C is a constant 95.621 mL/m2, a is 1 for males and 0 for females, b is 1 for right OLV and 0 for left OLV, c is BMI (kg/m2), and d is PIP (cmH2O).Conclusions: The TGM index is negatively correlated with the oxygen concentration of the nonventilated lung at 5 min after OLV. Sex, side of OLV, BMI and PIP are independently correlated with the TGM index.Trial registration: This study was registered at ChiCTR (www.chictr.org.cn, ChiCTR1900024220) on July 1, 2019.Key Words: tidal gas movement, TGM index, one-lung ventilation, lung collapse, double-lumen endobronchial tube, dynamic lung compliance, thoracoscopy

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

Cited by 55 publications

References 56 publications

Sevoflurane suppresses hypoxia-induced growth and metastasis of lung cancer cells via inhibiting hypoxia-inducible factor-1α

Sevoflurane suppresses hypoxia-induced growth and metastasis of lung cancer cells via inhibiting hypoxia-inducible factor-1α

Can Dexmedetomidine Improve Arterial Oxygenation and Intrapulmonary Shunt during One-lung Ventilation in Adults Undergoing Thoracic Surgery? A Meta-analysis of Randomized, Placebo-controlled Trials

Volume of Tidal Gas Movement in the Nonventilated Lung during One-lung Ventilation and its Relevant Factors

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