Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study
Abstract Background During thoracic surgery in lateral decubitus, one lung ventilation (OLV) may impair respiratory mechanics and gas exchange. We tested a strategy based on an open lung approach (OLA) consisting in lung recruitment immediately followed by a decremental positive-end expiratory press...
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doaj-ff3c68e8235b48f88c4aafb6c7cf33ce2020-11-25T03:37:16ZengBMCBMC Anesthesiology1471-22532018-10-011811910.1186/s12871-018-0624-3Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological studyMichela Rauseo0Lucia Mirabella1Salvatore Grasso2Antonella Cotoia3Savino Spadaro4Davide D’Antini5Franca Valentino6Livio Tullo7Domenico Loizzi8Francesco Sollitto9Gilda Cinnella10Department of Anesthesia and Intensive care, University of FoggiaDepartment of Anesthesia and Intensive care, University of FoggiaDepartment of Anesthesia and Intensive care, University of BariDepartment of Anesthesia and Intensive care, University of FoggiaDepartment of Anesthesia and Intensive care, University of FerraraDepartment of Anesthesia and Intensive care, University of FoggiaDepartment of Anesthesia and Intensive care, University of FoggiaDepartment of Anesthesia and Intensive care, University of FoggiaDepartment of Thoracic Surgery, University of FoggiaDepartment of Thoracic Surgery, University of FoggiaDepartment of Anesthesia and Intensive care, University of FoggiaAbstract Background During thoracic surgery in lateral decubitus, one lung ventilation (OLV) may impair respiratory mechanics and gas exchange. We tested a strategy based on an open lung approach (OLA) consisting in lung recruitment immediately followed by a decremental positive-end expiratory pressure (PEEP) titration to the best respiratory system compliance (CRS) and separately quantified the elastic properties of the lung and the chest wall. Our hypothesis was that this approach would improve gas exchange. Further, we were interested in documenting the impact of the OLA on partitioned respiratory system mechanics. Methods In thirteen patients undergoing upper left lobectomy we studied lung and chest wall mechanics, transpulmonary pressure (PL), respiratory system and transpulmonary driving pressure (ΔPRS and ΔPL), gas exchange and hemodynamics at two time-points (a) during OLV at zero end-expiratory pressure (OLVpre-OLA) and (b) after the application of the open-lung strategy (OLVpost-OLA). Results The external PEEP selected through the OLA was 6 ± 0.8 cmH2O. As compared to OLVpre-OLA, the PaO2/FiO2 ratio went from 205 ± 73 to 313 ± 86 (p = .05) and CL increased from 56 ± 18 ml/cmH2O to 71 ± 12 ml/cmH2O (p = .0013), without changes in CCW. Both ΔPRS and ΔPL decreased from 9.2 ± 0.4 cmH2O to 6.8 ± 0.6 cmH2O and from 8.1 ± 0.5 cmH2O to 5.7 ± 0.5 cmH2O, (p = .001 and p = .015 vs OLVpre-OLA), respectively. Hemodynamic parameters remained stable throughout the study period. Conclusions In our patients, the OLA strategy performed during OLV improved oxygenation and increased CL and had no clinically significant hemodynamic effects. Although our study was not specifically designed to study ΔPRS and ΔPL, we observed a parallel reduction of both after the OLA. Trial registration TRN: ClinicalTrials.gov, NCT03435523, retrospectively registered, Feb 14 2018.http://link.springer.com/article/10.1186/s12871-018-0624-3One lung ventilationRecruitment maneuverThoracic surgeryOpen lung approach |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Michela Rauseo Lucia Mirabella Salvatore Grasso Antonella Cotoia Savino Spadaro Davide D’Antini Franca Valentino Livio Tullo Domenico Loizzi Francesco Sollitto Gilda Cinnella |
spellingShingle |
Michela Rauseo Lucia Mirabella Salvatore Grasso Antonella Cotoia Savino Spadaro Davide D’Antini Franca Valentino Livio Tullo Domenico Loizzi Francesco Sollitto Gilda Cinnella Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study BMC Anesthesiology One lung ventilation Recruitment maneuver Thoracic surgery Open lung approach |
author_facet |
Michela Rauseo Lucia Mirabella Salvatore Grasso Antonella Cotoia Savino Spadaro Davide D’Antini Franca Valentino Livio Tullo Domenico Loizzi Francesco Sollitto Gilda Cinnella |
author_sort |
Michela Rauseo |
title |
Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study |
title_short |
Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study |
title_full |
Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study |
title_fullStr |
Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study |
title_full_unstemmed |
Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study |
title_sort |
peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study |
publisher |
BMC |
series |
BMC Anesthesiology |
issn |
1471-2253 |
publishDate |
2018-10-01 |
description |
Abstract Background During thoracic surgery in lateral decubitus, one lung ventilation (OLV) may impair respiratory mechanics and gas exchange. We tested a strategy based on an open lung approach (OLA) consisting in lung recruitment immediately followed by a decremental positive-end expiratory pressure (PEEP) titration to the best respiratory system compliance (CRS) and separately quantified the elastic properties of the lung and the chest wall. Our hypothesis was that this approach would improve gas exchange. Further, we were interested in documenting the impact of the OLA on partitioned respiratory system mechanics. Methods In thirteen patients undergoing upper left lobectomy we studied lung and chest wall mechanics, transpulmonary pressure (PL), respiratory system and transpulmonary driving pressure (ΔPRS and ΔPL), gas exchange and hemodynamics at two time-points (a) during OLV at zero end-expiratory pressure (OLVpre-OLA) and (b) after the application of the open-lung strategy (OLVpost-OLA). Results The external PEEP selected through the OLA was 6 ± 0.8 cmH2O. As compared to OLVpre-OLA, the PaO2/FiO2 ratio went from 205 ± 73 to 313 ± 86 (p = .05) and CL increased from 56 ± 18 ml/cmH2O to 71 ± 12 ml/cmH2O (p = .0013), without changes in CCW. Both ΔPRS and ΔPL decreased from 9.2 ± 0.4 cmH2O to 6.8 ± 0.6 cmH2O and from 8.1 ± 0.5 cmH2O to 5.7 ± 0.5 cmH2O, (p = .001 and p = .015 vs OLVpre-OLA), respectively. Hemodynamic parameters remained stable throughout the study period. Conclusions In our patients, the OLA strategy performed during OLV improved oxygenation and increased CL and had no clinically significant hemodynamic effects. Although our study was not specifically designed to study ΔPRS and ΔPL, we observed a parallel reduction of both after the OLA. Trial registration TRN: ClinicalTrials.gov, NCT03435523, retrospectively registered, Feb 14 2018. |
topic |
One lung ventilation Recruitment maneuver Thoracic surgery Open lung approach |
url |
http://link.springer.com/article/10.1186/s12871-018-0624-3 |
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