Apneic oxygen insufflation decreases the incidence of hypoxemia during one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A randomized controlled trial

Jung, Dae Myung; Ahn, Hyun Joo; Jung, Sin Ho; Yang, Mikyung; Kim, Jie Ae; Shin, Sumin; Jeon, Suyong

doi:10.1016/j.jtcvs.2017.02.054

Cited by 37 publications

(22 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Apnoeic oxygenation of the deflated lung during one‐lung ventilation reduces the likelihood of hypoxaemia and the need for resumption of double‐lung ventilation . This can be achieved via an endobronchial suction catheter or, during bronchial anastomosis formation, via a surgically‐placed catheter distal to the anastomosis.…”

Section: Apnoeic Oxygenation For the Avoidance Of Lung Movementmentioning

confidence: 99%

Uses and mechanisms of apnoeic oxygenation: a narrative review

Lyons

Callaghan

2019

Anaesthesia

View full text Add to dashboard Cite

Apnoeic oxygenation refers to oxygenation in the absence of spontaneous respiration or mechanical ventilation. It has been described in humans for over half a century and has seen a resurgence in interest given its potential to delay oxygen desaturation during airway management, especially with the advent of high-flow nasal cannulae. This narrative review summarises our current understanding of the mechanisms of gas exchange during apnoeic oxygenation and its diverse range of clinical applications, including its use at induction of anaesthesia and for the facilitation of 'tubeless anaesthesia'. Additional discussion covers use in critical care, obese, obstetric and paediatric sub-populations. The article also highlights current research efforts aiming to enhance the evidence base for the use of this technique.

show abstract

Section: Apnoeic Oxygenation For the Avoidance Of Lung Movementmentioning

confidence: 99%

Uses and mechanisms of apnoeic oxygenation: a narrative review

Lyons

Callaghan

2019

Anaesthesia

View full text Add to dashboard Cite

show abstract

“…However, the inhibition of hypoxemic pulmonary vasoconstriction (HPV), hypoxemia, generation of oxygen free radicals, ischemia/reperfusion (I/R) injury (5) and inflammatory reactions (6) may occur during OLV, and are mainly found in the lung being operated on, leading to lung injury, which is difficult to manage. Current solutions are continuous positive airway pressure and low-flow oxygen insufflation (7,8), which can reduce the accumulation of inflammatory cytokines and moisture, improve oxygenation and reduce lung injury. There is a reasonable selection of anesthetic or vasoactive drugs to protect the lungs, including dexmedetomidine, isoflurane (9,10), morphine and phenylephrine (11).…”

Section: Protective Effect Of Nicorandil On Collapse-induced Lung Injmentioning

confidence: 99%

Protective effect of nicorandil on collapse‑induced lung injury in rabbits by inhibiting apoptosis

Wang

et al. 2019

Int J Mol Med

View full text Add to dashboard Cite

The one-lung ventilation (OLV) technique is vital in thoracic surgery. However, it can result in severe lung injury, which is difficult to manage. The main solution at present is the use of ventilation strategies, including continuous positive oxygen pressure, low tidal volume and high frequency ventilation, and the administering of drugs, including phenylephrine, dexmedetomidine and morphine. However, the protective effect of these methods on the lungs is not sufficient to improve the prognosis of patients. Therefore, how to develop a novel protective drug remains an open question. Nicorandil, a mitochondrial (mito)KATP-specific opener, serves an important role in cardioprotection, although its effect on lung injury remains unclear. The present study examined the protective role of nicorandil against collapse-induced lung injury in rabbits undergoing OLV. changes in arterial oxygen saturation (SaO 2), arterial partial pressure for oxygen (PaO 2), wet/dry weight ratio, and the microstructure of tissues and cells were observed. Enzyme-linked immunosorbent assays were used to determine the concentrations of malondialdehyde (MDA) and tumor necrosis factor (TNF)-α, and the activity of superoxide dismutase (SOD) in rabbits treated with nicorandil. Terminal deoxynucleotidyl transferase transfer-mediated dUTP nick end-labeling was used to detect apoptosis and western blotting was used to analyze the relative proteins involved in apoptosis. Western blotting and reverse transcription-quantitative polymerase chain reaction analysis were used to examine the expression of hypoxia inducible factor 1α (HIF-1α), phosphatidylinositol-3-kinase (PI3K), protein kinase B (Akt) and nuclear factor (NF)-κB in the lungs of rabbits treated with nicorandil. The SaO 2 and PaO 2 in the high-dose group were significantly higher than those in the control group in the process of OLV. The wet/dry weight ratio, and the concentrations of MdA and TNF-α in the collapsed lung of the high-dose group were significantly lower than those in the control group. The activity of SOD in the high-dose group was significantly higher than that in the control group. The lung had improved microstructure and less apoptosis, which was determined by the Bax/Bcl2 ratio in the high-dose group. The expression levels of PI3K, phosphorylated Akt and HIF-1α were upregulated, whereas the expression of NF-κB was downregulated. In conclusion, nicorandil had a protective effect via inhibiting apoptosis in non-ventilated lung collapsed and re-expansion during OLV in the rabbit. It acted on mitoKATP through the PI3K/Akt signaling pathway.

show abstract

“…In the present issue of the Journal, Dr Frank Baciewicz raises several excellent questions regarding this trial by Jung and colleagues. 1 The first question asked is if there was a difference in results depending on the side of the procedure. Although relevant, with only 45 patients per group, it is likely that the trial was underpowered to detect differences between insufflation on the right and left sides of the body.…”

Section: Oxygen Insufflation During 1-lung Ventilationmentioning

confidence: 99%