Hypoxemia during One-lung Ventilation

Karzai, Waheedullah; Schwarzkopf, Konrad

doi:10.1097/aln.0b013e31819fb15d

Cited by 259 publications

(87 citation statements)

References 104 publications

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“…During thoracic surgery, one-lung ventilation (OLV) is essential to isolate the targeted lung [1]. However, there is a 4-10% risk of hypoxemia during OLV [1,2,3], and preventing this risk remains a major concern.…”

Section: Introductionmentioning

confidence: 99%

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Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test

Jung

Kim

et al. 2014

Korean J Anesthesiol

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BackgroundHypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP).MethodsIn total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began.ResultsPreemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05).ConclusionsPreemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.

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Section: Introductionmentioning

confidence: 99%

“…However, there is a 4-10% risk of hypoxemia during OLV [1,2,3], and preventing this risk remains a major concern. Ideally, the tidal volume should maintain adequate oxygenation and prevent hypoxemia during OLV [4], but the ideal tidal volume is debatable.…”

Section: Introductionmentioning

confidence: 99%

Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test

Jung

Kim

et al. 2014

Korean J Anesthesiol

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“…It should be emphasized that maintaining optimum oxygenation is crucial for preventing cellular hypoxia. (1)(2)(3) During OLV with the patient in the lateral decubitus position, there is a potential risk of significant intrapulmonary shunting of deoxygenated pulmonary arterial blood, which may result in hypoxemia. A consequence of the increase in pulmonary vascular resistance (PVR) in the independent (unventilated) lung, predominantly as a result of activated hypoxic pulmonary vasoconstriction (HPV), is a redistribution of blood flow in the ventilated dependent lung.…”

Section: Introductionmentioning

confidence: 99%

Hypoxia during one lung ventilation in thoracic surgery

2017

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Background. The technique of one lung ventilation (OLV) is used with the purpose of achieving isolation of the diseased lung being operated upon, using a doublelumen endobronchial tube. Thoracic surgical procedures which are performed in the lateral decubitus position, nowadays could not be imagined without OLV. In spite of advantages regarding surgical exposure, OLV is associated with serious respiratory impairment. Hypoxemia is considered to be the most important challenge during OLV. The goal of this study was to establish the magnitude of intrapulmonary shunt, as well as the immensity of hypoxia during general anesthesia with OLV. Materials and Methods. In this prospective interventional clinical study thirty patients were enrolled who underwent elective thoracic surgery with a prolonged period of OLV. The patients received balanced general anesthesia with fentanyl/propofol/ rocuronium. A double-lumen endobronchial tube was inserted in all patients, and mechanical ventilation with 50% oxygen in air was used during the entire study. Arterial blood gases were recorded in a lateral decubitus position with two-lung ventilation, at the beginning of OLV (OLV 0) and at 10 and 30 min. (OLV 10, OLV 30, respectively) after initiating OLV in all patients. Standard monitoring procedures were used. Arterial oxygenation (PaO2), arterial oxygen saturation (SaO2) and venous admixture percentage -intrapulmonary shunt (Qs/Qt %) were measured, as well as mean arterial pressure and heart rate during the same time intervals. For the purpose of this study, the quantitative value of Qs/Qt% was mathematically calculated using the blood gas analyser AVL Compact 3. A p value <0.05 was taken to

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“…Ventilatory impairment can result. Several reports have shown that hypoxemia is a frequent complication of improper placement or displacement of the DLT [4][5][6][7] . We believe that accurate preoperative determination of the appropriate depth of placement (ADP) will issue in proper intubation and smooth induction of anesthesia.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of MDCT for Predicting Left Double Lumen Endotracheal Tube Displacement during Supine to Lateral Repositioning of Patients

Tanigawa

Masumori

Okuda

et al. 2015

J St. Marianna Univ

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Multidetector-row computed tomography (MDCT) allows visualization and measurement of anatomical structures. Because we seek a reliable method by which we can predict displacement of the double lumen endotracheal tube (DLT) in patients when supine to lateral repositioning is required during surgery, we performed MDCT preoperatively for 84 patients scheduled for elective respiratory surgery with a left DLT. We obtained 3D MDCT reconstruction images of each patient's bronchus and then measured the distance between the vocal cords and the bifurcation of the left upper lobe bronchus. We defined this distance as the MDCT-derived appropriate depth of placement (ADP). We used two other methods to determine ADP: the standard measurement method based on the patient's height and the chest X-ray method based on the distance from the superior border of the sixth cervical vertebra to the tracheal bifurcation. During surgery, we evaluated the actual change in ADP when the patient was moved from the supine to the lateral position. We then compared the actual ADP with the MDCT-derived ADP to assess whether the MDCT-derived ADP predicts DLT displacement during the patient repositioning.We found that during surgery, the DLT had slipped out of position in 31 (44%) patients, had moved too deeply in 6 (7%), and had not changed in 41 (49%). Multiple logistic regression analysis showed that the MDCT-derived ADP was significantly associated with DLT displacement upon patient repositioning (odds ratio, 2.9; 95% CI, 1.5-5.6; p=0.002), whereas standard ADP and chest X-ray-derived ADP were not associated with DLT displacement. We postulate that various factors, such as extension or flexion of the neck and size of the DLT, may contribute the DLT displacement during patient repositioning.We believe, on the basis of our study data, that ADP derived from pre-operative MDCT will be useful for predicting DLT displacement when patients are moved from the supine to lateral position during surgery.

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Hypoxemia during One-lung Ventilation

Cited by 259 publications

References 104 publications

Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test

Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test

Hypoxia during one lung ventilation in thoracic surgery

Feasibility of MDCT for Predicting Left Double Lumen Endotracheal Tube Displacement during Supine to Lateral Repositioning of Patients

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