Dead space during one-lung ventilation

Tusman, Gerardo; Böhm, Stephan H.; Suárez-Sipmann, Fernando

doi:10.1097/aco.0000000000000153

Cited by 14 publications

(10 citation statements)

References 47 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Observation indicators: Qs/Qt(%), OI, PaCO 2 at T 1 , T 2 , T 3 , T 4 and T 5 ; P peak , P plat and Cdyn at T 1 , T 2 and T 3 ; the concentrations of IL-6 and TNF-α in venous blood at T 1 and T 5 ; clinical pulmonary infection score (CPIS) at the 1st day and 7th day after the operation (21).…”

Section: Methodsmentioning

confidence: 99%

“…During OLV, solely small tidal volume ventilation cannot decrease the occurrence of sheering injury of the lungs, which is close to alveolar trapping and re-expansion (6,21). Fernandez-Bustamante et al (16) noted that for obese patients with OLV, the ventilation-side lung more easily suffered from atelectasis, and that positive end-expiratory pressure (PEEP) was the most effective approach to keep the alveoli open, which could reduce the collapse of the alveoli (7,8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients

et al. 2019

View full text Add to dashboard Cite

Background: The present study aims to evaluate the influence of alveolar recruitment strategy (ARS) and positive end-expiratory pressure (PEEP) combined with autoflow on respiratory mechanics, the oxygen index (OI), pulmonary shut [Qs/Qt(%)], and the concentrations of IL-6 and TNF-α in venous blood after surgery in obese patients who experienced thoracic surgery with one-lung ventilation (OLV). Methods: A total of 36 obese patients with ASAII-III degree, who experienced selective pulmonary lobectomy, were within 36-74 years old, and had a BMI of 30-40 kg/m 2 , were randomly divided into two groups: control group (C group) and protective ventilation group (P group). In the P group, ARS was given once when OLV began. Then, ventilation at 7 mmHg of PEEP and autoflow were given. The P peak before OLV (T 1 ), at 30 minutes after OLV (T 2 ), and at the 5 minutes after two-lung ventilation (TLV) (T 3 ), and the changes of P plat and Cdyn were recorded. Then, arteriovenous blood was drawn at T 1 , T 2 , T 3 and T 4 (6 hours after the operation), blood-gas indicators, including SPO 2 , PaCO 2 and PaO 2 , were measured, and the value of Qs/Qt(%) was calculated. Afterwards, venous blood was collected at T 1 and T 5 (18 hours after surgery), and the concentrations of IL-6 and TNF-α were detected. The clinical pulmonary infection score (CPIS) was determined at the first day and seventh day after the operation.Results: In both groups, Cdyn and OI decreased, while P plat , P peak and Qs/Qt(%) increased (P<0.05) at T 2 , when compared with those at T 1 . At T 2 and T 3 , P plat and P peak decreased (P<0.05) in the P group, when compared with the C group. At T 2 , T 3 and T 4 , OI increased (P<0.05) in the P group, when compared with the C group. At T 2 , T 3 and T 4 , PaCO 2 and Qs/Qt(%) decreased in the P group, when compared with the C group. The concentrations of IL-6 and TNF-α decreased in the P group, when compared with the C group. Conclusions: The ventilation model of ARS and PEEP combined with autoflow can better reduce airway pressure and the production of injurious inflammatory cytokines in blood in obese patients. Furthermore, it can reduce Qs/Qt during and at 6 hours after thoracotomy, improve OI and maintain the acid-base balance of the internal environment, which may be applied in clinical work. This brings new enlightenment and needs to be clarified through further studies.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…In constant dead space volume given (VDaw), alveolar ventilation could vary significantly with changing frequency and amplitude, while minute ventilation will remained constant [4,5]. Measurements of alveolar and anatomical dead space volumes were problematic that prevented from using them in clinical practice [9,10] However, recent achievements in socalled volumetric capnography (VCap) and better understanding of its clinical impact helped in overcoming restrictions related to the CO 2 flow and the dead space [11,12]. At present, we are able to measure the dead space at the bedside.…”

Section: материал и методыmentioning

confidence: 99%

“…При заданном постоянном объеме мертвого пространства (Vdaw) альвеолярная вентиляция может значительно различаться при изменении частоты и амплитуды дыхания, тогда как минутная вентиляция легких остается неизменной [4,5]. Сложность измерения объемов альвеолярного и анатомического мертвого пространств представляло проблему, не позволявшую широко использовать эти данные в клинической практике [9,10]. Однако, использование так называемой объемной капнографии (VCap) и лучшее понимание ее клинического значения помогли преодолеть ограничения, связанные с оценкой потока CO 2 и объема мертвого пространства [11,12].…”

Section: Introductionunclassified

Volumetric Сapnography As a Tool for Evaluation of Alveolar Ventilation Effectiveness in Clinical Practice

Török

Depta

Донич

et al. 2018

Obŝaâ reanimatologiâ

View full text Add to dashboard Cite

The purpose of the study was to compare the relationship between the dead space volume and tidal volume (VD/VT) using volumetric capnography (VCap) during pressure controlled (PCV) and pressure supported (PSV) ventilation mode in the postoperative period.Materials and methods. 30 randomly assigned cardiac surgical patients undergoing CABG (coronary artery bypass grafting) using ECC (extracorporeal circuit) were included in an observational, prospective study. Patients were connected to the ventilator immediately after ICU admission. After that, monitoring VD/VT, CO2 production (VECO2) as well as ventilation parameters was carried out. The parameters during PCV and PSV mode were statistically evaluated using t-test.Results. Expiratory CO2 (ETCO2) concentration were not significantly different in both PCV or PSV (p=NS), although both VECO2 and minute ventilation (MV) increased during PSV mode (p<0.01). VD/VT in PSV mode was lower than in PCV. Gas exchange represented by alveolar ventilation (VA) was better during PSV (p<0.01). VA was also higher during PSV (p<0.05). The calculated VD/VT ratio differed between PCV and PSV mode (p<0.01).Conclusion. VCap represents a tool for monitoring of CO2 exchange effectivness. We registered a decrease in VD/VT with improved alveolar ventilation (VA) in PSV mode. VCap seems to be a suitable instrument for adjustment of protective lung ventilation.

show abstract

“…Tusman et al [ 49 ] showed that the highest pulse oximetry oxygen saturation (SpO 2 ), the lowest VD and the highest VTCO 2 ,br (CO 2 production per breath) occur at the PEEP level that keeps alveoli open. They also studied patients undergoing one-lung ventilation (OLV) during thoracic surgery [ 50 ]. In thoracic surgery one of the main goals of anesthesiologists is to maintain adequate minute ventilation while keeping tidal volume below a level that over-distends dependent lung units and produces VD and lung injury.…”

Section: Others Applications Of Vcapmentioning

confidence: 99%

Volumetric capnography: lessons from the past and current clinical applications

Verscheure

Massion²,

Verschuren

et al. 2016

Crit Care

View full text Add to dashboard Cite

Dead space is an important component of ventilation–perfusion abnormalities. Measurement of dead space has diagnostic, prognostic and therapeutic applications. In the intensive care unit (ICU) dead space measurement can be used to guide therapy for patients with acute respiratory distress syndrome (ARDS); in the emergency department it can guide thrombolytic therapy for pulmonary embolism; in peri-operative patients it can indicate the success of recruitment maneuvers. A newly available technique called volumetric capnography (Vcap) allows measurement of physiological and alveolar dead space on a regular basis at the bedside. We discuss the components of dead space, explain important differences between the Bohr and Enghoff approaches, discuss the clinical significance of arterial to end-tidal CO2 gradient and finally summarize potential clinical indications for Vcap measurements in the emergency room, operating room and ICU.

show abstract

Dead space during one-lung ventilation

Abstract: Monitoring dead space helps anesthesiologists monitor the status of the lung and find appropriate ventilatory settings during thoracic surgeries.

Cited by 14 publications

References 47 publications

Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients

Application of alveolar recruitment strategy and positive end-expiratory pressure combined with autoflow in the one-lung ventilation during thoracic surgery in obese patients

Volumetric Сapnography As a Tool for Evaluation of Alveolar Ventilation Effectiveness in Clinical Practice

Volumetric capnography: lessons from the past and current clinical applications

Contact Info

Product

Resources

About