Impact of pharmacological interventions on intrapulmonary shunt during one-lung ventilation in adult thoracic surgery: a systematic review and component network meta-analysis

Schorer, Raoul; Dombret, Anna-Luna; Hagerman, Andres; Bédat, Benoît; Putzu, Alessandro

doi:10.1016/j.bja.2022.08.039

Cited by 7 publications

(2 citation statements)

References 76 publications

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“…Our observation that oxygenation was reduced and intrapulmonary shunt increased during OLV compared to TLV confirms previous experimental 19 and clinical 29 findings. The fact that, during OLV, oxygenation was highest at PEEPtitr and PEEP15 might suggest that a shift of perfusion from the ventilated to the nonventilated lung played a minor role, if any at all.…”

Section: Discussionsupporting

confidence: 91%

Effects of Positive End-expiratory Pressure on Pulmonary Perfusion Distribution and Intrapulmonary Shunt during One-lung Ventilation in Pigs: A Randomized Crossover Study

Wittenstein,

Scharffenberg,

Fröhlich

et al. 2024

Anesthesiology

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Background During one-lung ventilation (OLV), positive end-expiratory pressure (PEEP) can improve lung aeration, but might over-distend lung units and increase intrapulmonary shunt. We hypothesized that higher PEEP shifts pulmonary perfusion from the ventilated to the non-ventilated lung, resulting in a U-shaped relationship with intrapulmonary shunt during OLV. Methods In nine anesthetized female pigs, a thoracotomy was performed and intravenous lipopolysaccharide infused to mimic the inflammatory response of thoracic surgery. Animals underwent OLV in supine position with PEEP of 0 cmH2O, 5 cmH2O, titrated to best respiratory system compliance, and 15 cmH2O (PEEP0, PEEP5, PEEPtitr, and PEEP15, respectively, 45 min each, Latin square sequence). Respiratory, hemodynamic, and gas exchange variables were measured. The distributions of perfusion and ventilation were determined by i.v. fluorescent microspheres and computed tomography, respectively. Results Compared to two lung ventilation, the driving pressure increased with OLV, irrespective of the PEEP level. During OLV, cardiac output was lower at PEEP15 (5.5 ± 1.5 l/min) than PEEP0 (7.6 ± 3 l/min) and PEEP5 (7.4 ± 2.9 l/min; P=0.004), while the intrapulmonary shunt was highest at PEEP0 (PEEP0: 48.1 ± 14.4 %; PEEP5: 42.4 ± 14.8 %; PEEPtitr: 37.8 ± 11.0 %; PEEP15: 39.0 ± 10.7 %; P=0.027). The relative perfusion of the ventilated lung did not differ among PEEP levels (PEEP0: 65.0 ± 10.6 %; PEEP5:68.7 ± 8.7 %; PEEPtitr: 68.2 ± 10.5 %; PEEP15: 58.4 ± 12.8%; P=0.096), but the centers of relative perfusion and ventilation in the ventilated lung shifted from ventral to dorsal, and from cranial to caudal zones with increasing PEEP. Conclusion In this experimental model of thoracic surgery, higher PEEP during OLV did not shift the perfusion from the ventilated to the non-ventilated lung, thus not increasing intrapulmonary shunt. Trial registration This study was registered and approved by the Landesdirektion Dresden, Germany (25-5131/496/33).

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Section: Discussionsupporting

confidence: 91%

Effects of Positive End-expiratory Pressure on Pulmonary Perfusion Distribution and Intrapulmonary Shunt during One-lung Ventilation in Pigs: A Randomized Crossover Study

Wittenstein,

Scharffenberg,

Fröhlich

et al. 2024

Anesthesiology

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“…The frequency of hypoxemia in thoracic surgeries that necessitate one-lung ventilation (OLV) varies between 5% and 10% [ 1 ]. Extracardiac right-to-left shunt (RLS) resulting from perfusion of the non-dependent lung is the predominant mechanism responsible for intraoperative hypoxemia during OLV [ 2 , 3 ]. Hypoxic pulmonary vasoconstriction (HPV) is the primary physiologic mechanism responsible for reducing the blood flow to the non-ventilated lung and reducing RLS.…”

Section: Introductionmentioning

confidence: 99%

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study

Raman¹,

Nair²,

Siddiqui³

et al. 2023

Cureus

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Context Deferasirox, an iron chelator, can potentially reduce intraoperative right-to-left shunt and improve oxygenation in patients undergoing thoracic surgery requiring one-lung ventilation (OLV) by potentiating hypoxic pulmonary vasoconstriction (HPV). Aim The aim was to determine the effect of deferasirox on the intraoperative shunt fraction (SF) of patients undergoing thoracic surgery using OLV. Study design and settings This was a prospective, single-blind, randomized, controlled study. The study was conducted at a tertiary-care hospital. Methods Before surgery, 64 patients were allocated to two groups comprising 32 patients each. Group D patients were administered deferasirox, while those in group C were given a placebo. We included patients with the American Society of Anesthesiologists physical status III or IV, aged 18-60 years, undergoing elective thoracic surgery needing OLV. SF was the primary outcome variable. Secondary outcome variables were arterial oxygen tension (PaO 2 ), peripheral oxygen saturation (SpO 2 ), the ratio of PaO 2 and inspired oxygen concentration (P/F), and complications such as desaturation episodes, hypotension, and tachycardia. Results Baseline and postoperative values of outcome variables were statistically similar in both groups. Intraoperative values of SF were lower and PaO 2 , SpO 2 , and P/F were higher in group D. The incidence of intraoperative desaturation was lower in group D. Conclusion We conclude that pre-treatment with deferasirox reduces intraoperative SF and improves oxygenation during thoracic surgery using OLV.

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Coordination‐Driven Nanomedicine Mitigates One‐Lung Ventilation‐Induced Lung Injury via Radicals Scavenging and Cell Pyroptosis Inhibition

Fan,

Ou,

Xiao

et al. 2024

Small

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One‐lung ventilation (OLV) during thoracic surgery often leads to post‐operative complications, yet effective pharmacological interventions are lacking. This study reports a baicalin‐based metal‐coordination nanomedicine with disulfiram (DSF) co‐loading to address one‐lung ventilation‐induced lung injury and reperfusion injury (OLV‐LIRI). Baicalin, known for its robust antioxidant properties, suffers from poor water solubility and stability. Leveraging nanotechnology, baicalin's coordination is systematically explored with seven common metal ions, designing iron/copper‐mediated binary coordination nanoparticles to overcome these limitations. The self‐assembled nanoparticles, primarily formed through metal coordination and π–π stacking forces, encapsulated DSF, ensuring high colloidal stability in diverse physiological matrices. Upon a single‐dose administration via endotracheal intubation, the nanoparticles efficiently accumulate in lung tissues and swiftly penetrate the pulmonary mucosa. Intracellularly, baicalin exhibits free radical scavenging activity to suppress inflammation. Concurrently, the release of Cu2+ and DSF enables the in situ generation of CuET, a potent inhibitor of cell pyroptosis. Harnessing these multifaceted mechanisms, the nanoparticles alleviate lung injury symptoms without notable toxic side effects, suggesting a promising preventive strategy for OLV‐LIRI.

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Impact of pharmacological interventions on intrapulmonary shunt during one-lung ventilation in adult thoracic surgery: a systematic review and component network meta-analysis

Cited by 7 publications

References 76 publications

Effects of Positive End-expiratory Pressure on Pulmonary Perfusion Distribution and Intrapulmonary Shunt during One-lung Ventilation in Pigs: A Randomized Crossover Study

Effects of Positive End-expiratory Pressure on Pulmonary Perfusion Distribution and Intrapulmonary Shunt during One-lung Ventilation in Pigs: A Randomized Crossover Study

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study

Coordination‐Driven Nanomedicine Mitigates One‐Lung Ventilation‐Induced Lung Injury via Radicals Scavenging and Cell Pyroptosis Inhibition

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