Alveolar Recruitment Maneuvers for One-Lung Ventilation During Thoracic Anesthesia

Abstract

Especially during thoracic surgery, anesthesiologists have to cope with both the drastic alteration of normal pulmonary physiology and the mechanical stress on the lung tissue induced by ventilation. These problems result from the total collapse of the lung being operated on and the partial collapse of the ventilated other lung. In addition, technical factors inherent to thoracic surgery and the patient's condition potentiate such adverse effects. Traditional ventilatory settings described for thoracic surgery have not led to a decrease in the incidence of hypoxemia or perioperative atelectasis. However, lung recruitment maneuvers and ventilatory strategies are aimed at resolving lung collapse in mechanically ventilated patients, improving lung function, and decreasing the rate of post-operative pulmonary complications directly related to lung collapse. This article summarizes recent evidence for the role that lung recruitment maneuvers play during one-lung ventilation anesthesia.

Awake or intubated surgery in diagnosis of interstitial lung diseases? A prospective study

“…In both groups, lung recruitment manoeuvres were performed according to Tusman protocol. 15 After the procedure, patients were discharged to the ward with a standardized therapy consisting of Acetaminophen 1 gr EV every 8 hours. Rescue therapy for pain (e.g.…”

Anesthesia and fast-track in video-assisted thoracic surgery (VATS): from evidence to practice

“…Whether additional RM are to be employed routinely or just in case of desaturation is yet to be determined. A final RM after the re-expansion of the non-ventilated lung is recommended (50), and it should be performed at lower pressure levels in order to prevent damage to surgical staples (49,51).…”

Dead space during one-lung ventilation

“…Because the alveolar dead space comprises alveoli with an excess of ventilation in relation to their perfusion (Fig. To date, alveolar overdistension is the main reason for the high alveolar dead space typically seen during OLV because the tidal volume of 6 ml/kg currently recommended is deemed excessive for ventilating the dependent single lung [32], which receives an increased perfusion due to the effects of gravitational forces [33]. To date, alveolar overdistension is the main reason for the high alveolar dead space typically seen during OLV because the tidal volume of 6 ml/kg currently recommended is deemed excessive for ventilating the dependent single lung [32], which receives an increased perfusion due to the effects of gravitational forces [33].…”

“…This LPV combines the use of low tidal volume and plateau pressure with sufficient levels of PEEP [40]. We believe that this tidal volume is still excessively high during OLV due to obvious anatomical and physiological reasons [32]. However, the recommended tidal volume of 6 ml/kg during TLV needs to be revisited for OLV.…”

“…Dead space during one-lung ventilation Tusman et al www.co-anesthesiology.com A way to further decrease the risk of VILI is to apply the open-lung concept [32,43]. This is a lung protective ventilatory strategy that opens up the lungs by applying a lung recruitment maneuver that consists of a brief and controlled step-wise increment in airway pressure followed by the selection of a level of PEEP above the lungs' closing pressure (i.e., the PEEP level at which the lungs start to collapse again) during a decremental PEEP titration.…”