Masakazu Yasuuji1, Shinji Kusunoki2, Hiroshi Hamada3, Masashi Kawamoto3. 1. Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551, Japan. Electronic address: yasuuji@hiroshima-u.ac.jp. 2. Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551, Japan. 3. Department of Anesthesiology and Critical Care, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
Abstract
STUDY OBJECTIVE: To investigate whether a maneuver for repeated cycles of collapse and reexpansion of the operative lung, termed "intermittent reinflation" (IR), to counter hypoxemia during one-lung ventilation (OLV), results in a time-dependent alteration of extravascular lung water. DESIGN: Prospective, randomized clinical study. SETTING:Operating room and postsurgical intensive care unit of a university hospital. PATIENTS: 36 ASA physical status 1 and 2 patients undergoing elective, video-assisted thoracic surgery for lung tumors. INTERVENTIONS: Patients were randomly assigned to two groups. Group C consisted of 18 patients whose nondependent lung was kept collapsed during OLV, while Group IR included 18 patients with IR that consisted of 4 separate, 10-second manual inflations and 5-second openings within one minute at intervals of 20 minutes during OLV. MEASUREMENTS: Perioperative parameters included transcutaneous oxygen saturation (SpO2), hemodynamic data, extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) as determined by the single-indicator transpulmonary thermodilution technique, and partial pressure of arterial oxygen/inspired oxygen fraction (PaO2/FIO2) ratio. MAIN RESULTS: Group IR had significantly higher SpO2 at 20 minutes after commencement of OLV (98.9% vs 96.3%, P = 0.029) and average SpO2 throughout OLV (98.7% vs 97.0%, P = 0.020). Hemodynamic data, EVLWI, PVPI, andPaO2/FIO2 ratio did not differ between the groups, and there were no differences between groups in postoperative morbidity or hospital stay. CONCLUSIONS: Intermittent reinflation had a beneficial effect on oxygenation during OLV, without any significant effects on EVLW or postoperative outcomes.
RCT Entities:
STUDY OBJECTIVE: To investigate whether a maneuver for repeated cycles of collapse and reexpansion of the operative lung, termed "intermittent reinflation" (IR), to counter hypoxemia during one-lung ventilation (OLV), results in a time-dependent alteration of extravascular lung water. DESIGN: Prospective, randomized clinical study. SETTING: Operating room and postsurgical intensive care unit of a university hospital. PATIENTS: 36 ASA physical status 1 and 2 patients undergoing elective, video-assisted thoracic surgery for lung tumors. INTERVENTIONS:Patients were randomly assigned to two groups. Group C consisted of 18 patients whose nondependent lung was kept collapsed during OLV, while Group IR included 18 patients with IR that consisted of 4 separate, 10-second manual inflations and 5-second openings within one minute at intervals of 20 minutes during OLV. MEASUREMENTS: Perioperative parameters included transcutaneous oxygen saturation (SpO2), hemodynamic data, extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) as determined by the single-indicator transpulmonary thermodilution technique, and partial pressure of arterial oxygen/inspired oxygen fraction (PaO2/FIO2) ratio. MAIN RESULTS: Group IR had significantly higher SpO2 at 20 minutes after commencement of OLV (98.9% vs 96.3%, P = 0.029) and average SpO2 throughout OLV (98.7% vs 97.0%, P = 0.020). Hemodynamic data, EVLWI, PVPI, and PaO2/FIO2 ratio did not differ between the groups, and there were no differences between groups in postoperative morbidity or hospital stay. CONCLUSIONS: Intermittent reinflation had a beneficial effect on oxygenation during OLV, without any significant effects on EVLW or postoperative outcomes.