BACKGROUND: This study was conducted to determine whether an alveolar recruitment strategy (ARS) applied during two-lung ventilation (TLV) just before starting one-lung ventilation (OLV) improves ventilatory efficiency. METHODS: Subjects were randomly allocated to two groups: (i) control group: ventilation with tidal volume (VT) of 8 or 6 ml kg(-1) for TLV and OLV, respectively, and (ii) ARS group: same ventilatory pattern with ARS consisting of 10 consecutive breaths at a plateau pressure of 40 and 20 cm H(2)O PEEP applied immediately before and after OLV. Volumetric capnography and arterial blood samples were recorded 5 min (baseline) and 20 min into TLV, at 20 and 40 min during OLV, and finally 10 min after re-establishing TLV. RESULTS:Twenty subjects were included in each group. In all subjects, the airway component of dead space remained constant during the study. Compared with baseline, the alveolar dead space ratio (VD(alv)/VT(alv)) increased throughout the protocol in the control but decreased in the ARS group. Differences in VD(alv)/VT(alv) between groups were significant (P<0.001). Except for baseline, all values in kPa (sd) were higher in the ARS than in the control group (P<0.001), respectively [70 (7) and 55 (9); 33 (9) and 24 (10); 33 (8) and 22 (10); 70 (7) and 55 (10)]. CONCLUSIONS: Recruitment of both lungs before instituting OLV not only decreased alveolar dead space but also improved arterial oxygenation and the efficiency of ventilation.
RCT Entities:
BACKGROUND: This study was conducted to determine whether an alveolar recruitment strategy (ARS) applied during two-lung ventilation (TLV) just before starting one-lung ventilation (OLV) improves ventilatory efficiency. METHODS: Subjects were randomly allocated to two groups: (i) control group: ventilation with tidal volume (VT) of 8 or 6 ml kg(-1) for TLV and OLV, respectively, and (ii) ARS group: same ventilatory pattern with ARS consisting of 10 consecutive breaths at a plateau pressure of 40 and 20 cm H(2)O PEEP applied immediately before and after OLV. Volumetric capnography and arterial blood samples were recorded 5 min (baseline) and 20 min into TLV, at 20 and 40 min during OLV, and finally 10 min after re-establishing TLV. RESULTS: Twenty subjects were included in each group. In all subjects, the airway component of dead space remained constant during the study. Compared with baseline, the alveolar dead space ratio (VD(alv)/VT(alv)) increased throughout the protocol in the control but decreased in the ARS group. Differences in VD(alv)/VT(alv) between groups were significant (P<0.001). Except for baseline, all values in kPa (sd) were higher in the ARS than in the control group (P<0.001), respectively [70 (7) and 55 (9); 33 (9) and 24 (10); 33 (8) and 22 (10); 70 (7) and 55 (10)]. CONCLUSIONS: Recruitment of both lungs before instituting OLV not only decreased alveolar dead space but also improved arterial oxygenation and the efficiency of ventilation.
Authors: Douglas A Colquhoun; Bhiken I Naik; Marcel E Durieux; Amy M Shanks; Sachin Kheterpal; S Patrick Bender; Randal S Blank Journal: Anesth Analg Date: 2018-02 Impact factor: 5.108
Authors: Ary Serpa Neto; Nicole P Juffermans; Sabrine N T Hemmes; Carmen S V Barbas; Martin Beiderlinden; Michelle Biehl; Ana Fernandez-Bustamante; Emmanuel Futier; Ognjen Gajic; Samir Jaber; Alf Kozian; Marc Licker; Wen-Qian Lin; Stavros G Memtsoudis; Dinis Reis Miranda; Pierre Moine; Domenico Paparella; Marco Ranieri; Federica Scavonetto; Thomas Schilling; Gabriele Selmo; Paolo Severgnini; Juraj Sprung; Sugantha Sundar; Daniel Talmor; Tanja Treschan; Carmen Unzueta; Toby N Weingarten; Esther K Wolthuis; Hermann Wrigge; Marcelo Gama de Abreu; Paolo Pelosi; Marcus J Schultz Journal: Ann Transl Med Date: 2018-01
Authors: Yong Seon Choi; Mi Kyung Bae; Shin Hyung Kim; Ji-Eun Park; Soo Young Kim; Young Jun Oh Journal: Yonsei Med J Date: 2015-09 Impact factor: 2.759