Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation

Şentürk, Nüzhet; Dilek, Ahmet; Çamcı, Emre; Şentürk, Evren; Orhan, Mukadder; Tuğrul, Mehmet; Pembeci, Kamil

doi:10.1053/j.jvca.2004.11.013

Cited by 64 publications

(40 citation statements)

References 16 publications

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“…Peak airway and plateau pressure were significantly higher in the VCV, oxygen tension smaller and intrapulmonary shunt more pronounced. Other studies have confirmed these findings of improved oxygenation, reporting significant lower peak and plateau pressure values when using PCV 56 . Despite the application of 4 cm H 2 O PEEP in the study of Senturk et al, airway pressures in the PCV-PEEP mode were still lower compared with VCV with ZEEP.…”

Section: Ventilatortion Strategysupporting

confidence: 52%

“…1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 16 oxygenation and decreased the shunt fraction. Also Senturk et al demonstrated that PEEP improved oxygenation during OLV 56 . Response to PEEP during OLV seems to be individual and therefore has to be evaluated during ventilation 57 .…”

Section: Ventilatortion Strategymentioning

confidence: 97%

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Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Beck‐Schimmer

Schimmer

2010

Best Practice & Research Clinical Anaesthesiology

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Tidal volumes have tremendously decreased over the last decades from <15 ml kg(-1) to approximately 6 ml kg(-1) actual body weight. Guidelines, widely agreed and used, exist for patients with acute lung injury or acute respiratory distress syndrome (ARDS). However, it is questionable if data created in patients with acute lung injury or ARDS from ventilation on intensive care units can be transferred to healthy patients undergoing surgery. Consensus criteria regarding this topic are still missing because only a few randomised controlled trials have been performed to date, focussing on the use of the best intra-operative tidal volume. The same problem has been observed regarding the application of positive end-expiratory pressure (PEEP) and intra-operative lung recruitment. This article provides an overview of the current literature addressing the size of tidal volume, the use of PEEP and the application of the open-lung concept in patients without acute lung injury or ARDS. Pathophysiological aspects of mechanical ventilation are elucidated. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 2 AbstractTidal volumes have tremendously decreased over the last decades from greater than

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Section: Ventilatortion Strategysupporting

confidence: 52%

Section: Ventilatortion Strategymentioning

confidence: 97%

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Beck‐Schimmer

Schimmer

2010

Best Practice & Research Clinical Anaesthesiology

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“…Our result showed a lower Ppeak in group P but not better oxygenation. Although previous study implied PCV was in association with better oxygenation during OLV (26), PCV per se did not show any effect on gas exchange (27,28). We set the same PEEP value in both groups and this maybe the main reason why there was no significant difference with oxygenation between two groups.…”

Section: Discussionmentioning

confidence: 89%

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy

Zhu¹,

Fang²,

Ling³

et al. 2017

J. Thorac. Dis.

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Background: It is controversial as to which ventilation mode is better during one-lung ventilation (OLV). This study was designed to figure out whether there was any difference between volume controlled ventilation (VCV) and pressure controlled ventilation (PCV) on oxygenation and postoperative complications under the condition of protective ventilation (PV).Methods: Sixty-five patients undergoing video-assisted thoracoscopic lobectomy were randomized into two groups. Patients in group V received VCV mode during OLV while patients in group P received PCV.The tidal volume (VT) in both groups was 6 mL per predicted body weight (PBW). Positive end-expiratory pressure (PEEP) was set at the level of 5 cmH 2 O in both groups. Arterial gas analysis were performed preoperatively with room air (T 0 ), at 15 mins (T 1 ) and 1 h (T 2 ) after OLV, at the end of OLV (T 3 ), 30 min after PACU admission (T 4 ), 24 h after surgery (post-operative day 1, POD 1 ) and 48 h after surgery (postoperative day 2, POD 2 ). Peak inspiratory airway pressure (Ppeak) and plateau airway pressure (Pplat) were recorded at T 1 , T 2 and T 3 . The perioperative complications were also recorded.Result: Sixty-four patients completed this study. Ppeak in group V was significantly higher than that in group P (T 1 22.3±2.9 vs. 18.7±2.1 cmH 2 O; T 2 22.2±2.8 vs. 18.7±2.6 cmH 2 O). There were no differences with Pplat and intraoperative oxygenation index (T 1 203.3±109.7 vs. 198.1±93.4; T 2 216.8±79.1 vs. 232.1±101.4).The postoperative oxygenation index (T 4 525.0±160.9 vs. 520.7±127.1, post-operative day 1 (POD 1 ) 452.1±161.3 vs. 446.1±109.1; post-operative day 2 (POD 2 ) 403.8±93.4 vs. 396.7±92.8) and postoperative complications were also comparable between these two groups.Conclusions: When they were utilized during OLV, PCV and VCV had the same performance on the intraoperative oxygenation and postoperative complications under the condition of PV. J Thorac Dis 2017;9(5):1303-1309 jtd.amegroups.com ventilation (PCV) with low VT (6 mL/kg) was associated with lower incidence of postoperative lung dysfunction than volume controlled ventilation (VCV) with large VT (10 mL/kg). In 2007, Schultz et al. (5) published recommendations on intraoperative VT and suggested utilizing lower VT (≤6 mL/kg) in patients with abnormal lungs and/or risk factors for ALI.With further studying of small VT ventilation, some new findings came out. Blum et al. (6) showed that the incidence of postoperative ARDS was 0.2% in a general surgical population and the intraoperative risk factor included driver pressure instead of low tide volume. In thoracic surgery, the expected incidence of postoperative ALI was as high as 4.2% (7) and the independent risk factors included intraoperative ventilatory pressure index instead of VT. designed a study to prove their hypothesis that higher VT would be associated with higher risk of respiratory failure secondary to ALI, but the result showed that mean first hour peak airway pressure but not VT was associated with ALI. The clinical resea...

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“…Moreover, comparisons of cardiac output and pulmonary pressure would probably offer some further explanations of the findings. However, in several previous studies [12], including several with OLV [11] [13] [14], it has been shown that central venous blood sampling can be used to measure Qs/Qt and can be assumed to be reliable. In practice, pulmonary arterial catheters are associated with several complications, and they are very rarely used during thoracic surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This is a method which has been preferred by many authors [11]- [13]. Qs/Qt was calculated from the formula below, with respiratory quotient (RQ) = 0.8 and SaO 2 = arterial oxygen saturation.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

Büget¹,

Sungur²,

Özkan³

et al. 2015

OJAnes

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Effects of positive end-expiratory pressure on ventilatory and oxygenation parameters during pressure-controlled one-lung ventilation

Cited by 64 publications

References 16 publications

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Perioperative tidal volume and intra-operative open lung strategy in healthy lungs: where are we going?

Pressure-controlled versus volume-controlled ventilation during one-lung ventilation for video-assisted thoracoscopic lobectomy

The Effect of Dexmedetomidine on Oxygenation and Intrapulmonary Shunt during One Lung Ventilation

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