Oxygenation and hemodynamic changes during one-lung ventilation: effects of CPAP10, PEEP10, and CPAP10/PEEP10.

The effects of 10 cm H2O positive end-expiratory pressure (PEEP10), 10 cm H2O continuous positive airway pressure (CPAP10), and their combination (CPAP10/PEEP10) on oxygenation and hemodynamics were studied in 20 patients undergoing one-lung ventilation (OLV) with 50% nitrous oxide, isoflurane, and oxygen. Compared to OLV alone, CPAP10 and CPAP10/PEEP10 significantly increased PaO2 (from 80 +/- 6 to 125 +/- 11 and 137 +/- 17 mmHg, respectively); increased SaO2 (from 93.9 +/- 0.8 to 97.1 +/- 0.5 and 97.0 +/- 0.6%, respectively); and decreased Qs/Qt% (from 36.4 +/- 1.6 to 26.2 +/- 2.0 and 23.2 +/- 2.0%, respectively). Although not statistically significant, PEEP10 caused an increase in PaO2 (to 105 +/- 12 mmHg) and a decrease in Qs/Qt% (to 27.6 +/- 2.1%), which are of clinical significance. However, CPAP10/PEEP10 caused a significant decrease in cardiac output (from 4.50 +/- 0.26 to 3.83 +/- 0.22 L/min), stroke volume (58.6 +/- 3.0 to 52.8 +/- 2.9 mL/beat), and oxygen delivery (653 +/- 39 to 590 +/- 38 mL/min). Application of CPAP10, PEEP10 or their combination had no significant effect on heart rate, arterial, pulmonary arterial, mean pulmonary capillary wedge or central venous pressures, systemic or pulmonary vascular resistances, or mixed venous oxygen saturation. Overall, CPAP10 had the most beneficial effect on oxygenation and hemodynamics during OLV with 50% N2O, isoflurane and oxygen.