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Prospective, randomized, controlled evaluation of the preventive effects of positive end-expiratory pressure on patient oxygenation during one-lung ventilation

Published online by Cambridge University Press:  11 July 2005

G. Mascotto ,
M. Bizzarri ,
M. Messina ,
E. Cerchierini ,
G. Torri ,
A. Carozzo  and
A. Casati
G. Mascotto
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
M. Bizzarri
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
M. Messina
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
E. Cerchierini
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
G. Torri
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
A. Carozzo
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
A. Casati
Affiliation:
Vita-Salute University of Milan, IRCCS H. San Raffaele, Department of Anaesthesiology, Milan, Italy
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Extract

Summary

Background and objective: This prospective, randomized, controlled study evaluated the effects on oxygenation by applying a selective and patient-specific value of positive end-expiratory pressure (PEEP) to the dependent lung during one-lung ventilation.

Methods: Fifty patients undergoing thoracic surgery under combined epidural/general anaesthesia were randomly allocated to receive zero PEEP (Group ZEEP, n = 22), or the preventive application of PEEP, optimized on the best thoracopulmonary compliance (Group PEEP, n = 28). Patients' lungs were mechanically ventilated with the same setting during two- and one-lung ventilation (FiO2 = 0.5; VT = 9 mL kg−1, inspiratory : expiratory time = 1 : 1, inspiratory pause = 10%).

Results: Lung-chest wall compliance decreased in both groups during one-lung ventilation, but patients of Group PEEP had 10% higher values than patients with no end-expiratory pressure (ZEEP) applied – Group ZEEP (P < 0.05). During closed chest one-lung ventilation, the PaO2 : FiO2 ratio was lower in Group PEEP (232 ± 88) than in Group ZEEP (339 ± 97) (P < 0.05); but no further differences were reported throughout the study. No differences were reported between the two groups in the need for 100% oxygen ventilation (10 patients of Group ZEEP (45%) and 14 patients of Group PEEP (50%) (P = 0.78)) or re-inflation of the operated lung during surgery (two patients of Group ZEEP (9%) and three patients of Group PEEP (10%) (P = 0.78)). Postanaesthesia care unit discharge required 48 min (25th–75th percentiles: 32–58 min) in Group PEEP and 45 min (30–57 min) in Group ZEEP (P = 0.60).

Conclusions: The selective application of PEEP to the dependent, non-operated lung increases the lung–chest wall compliance during one-lung ventilation, but does not improve patient oxygenation.

Keywords

ANAESTHESIA, CONDUCTION, anaesthesia, epiduralANAESTHESIA, generalMONITORING, intraoperativeSPECIALTIES, SURGICAL, thoracic surgerySURGICAL PROCEDURES, OPERATIVE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 20 , Issue 9 , September 2003 , pp. 704 - 710
Copyright
© 2003 European Society of Anaesthesiology

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