Clinical Management of One-Lung Ventilation

Lohser, Jens; Ishikawa, Seiji

doi:10.1007/978-1-4419-0184-2_6

Cited by 10 publications

(10 citation statements)

References 120 publications

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“…We found that V T was around 6 ml/kg, and PEEP was set around 4 cm H 2 O in most patients. These findings were consistent with recent studies or textbook oriented lung protective strategy [ 15 , 21 , 22 ]. We also found that high F I O 2 was frequently used during OLV.…”

Section: Discussionsupporting

confidence: 93%

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Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: a prospective observational study

et al. 2018

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BackgroundThe interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FIO2). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery.MethodsWe performed a prospective observational two-center study in Japan. Patients scheduled for thoracic surgery with OLV from April to October 2014 were eligible. We recorded ventilator settings (FIO2, VT, driving pressure (ΔP), and PEEP) and calculated the time-weighted average (TWA) of ventilator settings for the first 2 h of OLV. PPCs occurring within 7 days of thoracotomy were investigated. Associations between ventilator settings and the incidence of PPCs were examined by multivariate logistic regression.ResultsWe analyzed perioperative information, including preoperative characteristics, ventilator settings, and details of surgery and anesthesia in 197 patients. Pressure control ventilation was utilized in most cases (92%). As an initial setting for OLV, an FIO2 of 1.0 was selected for more than 60% of all patients. Throughout OLV, the median TWA FIO2 of 0.8 (0.65-0.94), VT of 6.1 (5.3-7.0) ml/kg, ΔP of 17 (15-20) cm H2O, and PEEP of 4 (4-5) cm H2O was applied. Incidence rate of PPCs was 25.9%, and FIO2 was independently associated with the occurrence of PPCs in multivariate logistic regression. The adjusted odds ratio per FIO2 increase of 0.1 was 1.30 (95% confidence interval: 1.04-1.65, P = 0.0195).ConclusionsHigh FIO2 was applied to the majority of patients during OLV, whereas low VT and slight degree of PEEP were commonly used in our survey. Our findings suggested that a higher FIO2 during OLV could be associated with increased incidence of PPCs.Electronic supplementary materialThe online version of this article (10.1186/s12871-018-0476-x) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 93%

“…We also found that high F I O 2 was frequently used during OLV. These findings, however, were inconsistent with recent recommended management [ 22 ]. An F I O 2 of 1.0 was classically a routine component of OLV [ 15 , 23 ].…”

Section: Discussioncontrasting

confidence: 71%

Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: a prospective observational study

et al. 2018

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“…Three of the four patients undergoing VATS were ventilated with 100% oxygen throughout to facilitate absorption atelectasis in the isolated lung . In some open cases, however, the fraction of inspired oxygen was reduced when possible in an attempt to reduce the potentially deleterious effects of high concentrations of inspired oxygen .…”

Section: Methodsmentioning

confidence: 85%

Bending the rules: a novel approach to placement and retrospective experience with the 5 French Arndt endobronchial blocker in children <2 years

Templeton

Downard

Simpson

et al. 2016

Pediatric Anesthesia

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Our technique of placing a 35-45° bend in the AEB, extraluminal placement, and observed manipulation with a video-assisted flexible fiberoptic bronchoscope (FFB) within the trachea can be used to achieve consistent lung isolation in patients <2 undergoing thoracic surgery. When the use of a FFB proves unsuccessful, fluoroscopy can provide an alternative solution to successful placement. Significant respiratory derangements without long-term sequelae will occur in a majority of these patients during OLV. Several different approaches to intraoperative analgesia did not impede extubation in the early postoperative period.

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“…[ 51 ] Pressure controlled ventilation, by virtue of its decelerating flow reduces peak inspiratory pressure and allows for more uniform distribution of tidal volume and improvement of static and dynamic compliance. [ 52 ] In spite of limited evidence regarding the role of pressure controlled ventilation in COPD patients, it has been suggested as an alternative when other measures to prevent air trapping fail. [ 15 ]…”

Section: Intraoperative Managementmentioning

confidence: 99%

Anaesthesia for patient with chronic obstructive pulmonary disease

2015

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The chronic obstructive pulmonary disease has become a disease of public health importance. Among the various risk factors, smoking remains the main culprit. In addition to airway obstruction, the presence of intrinsic positive end expiratory pressure, respiratory muscle dysfunction contributes to the symptoms of the patient. Perioperative management of these patients includes identification of modifiable risk factors and their optimisation. Use of regional anaesthesia alone or in combination with general anaesthesia improves pulmonary functions and reduces the incidence of post-operative pulmonary complications.

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Clinical Management of One-Lung Ventilation

Cited by 10 publications

References 120 publications

Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: a prospective observational study

Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: a prospective observational study

Bending the rules: a novel approach to placement and retrospective experience with the 5 French Arndt endobronchial blocker in children <2 years

Anaesthesia for patient with chronic obstructive pulmonary disease

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