Prediction of arterial oxygen tension during one-lung ventilation: Analysis of preoperative and intraoperative variables

Guénoun, Tamara; Journois, Didier; Silleran-Chassany, Jacqueline; Frappier, Jérôme; D’Attellis, Nicola; Salem, Antoinette; Safran, D.

doi:10.1053/jcan.2002.31067

Cited by 47 publications

(31 citation statements)

References 11 publications

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“…However, the efficiency of this simple technique depends on the importance of the shunt-like effect and hypoxemia that requires treatment. 3,4 We completely agree with Drs. Tripathi and Papadimos that oxygen saturation measured by pulse oximetry (SpO 2 ) below 90% is an arbitrary limit.…”

supporting

confidence: 72%

“…Inhaled nitric oxide can inhibit hypoxic pulmonary vasoconstriction in patients with chronic obstructive pulmonary disease breathing room air 2 ; however, during OLV this gas vasodilates ventilated lung areas, shifting the pulmonary blood flow toward these zones without modifying hypoxic pulmonary vasoconstriction. 3 Regarding the use of inhaled nitric oxide, a European board of experts on this topic concluded that there is no evidence to support the routine use of inhaled nitric oxide for the prevention or reversal of hypoxemia during OLV, although some patients with severe hypoxemia may benefit from this drug. 4 On the other hand, the text suggests that inhaled nitric oxide improves hypoxemia only when it is used with positive end-expiratory pressure, but it has also been useful when administered without positive end-expiratory pressure in patients with severe hypoxemia.…”

mentioning

confidence: 99%

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Pharmacological Treatment of Hypoxemia during One-lung Ventilation

Rozé¹,

Lafargue²,

Ouattara³

2011

Anesthesiology

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confidence: 72%

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confidence: 99%

Pharmacological Treatment of Hypoxemia during One-lung Ventilation

Rozé¹,

Lafargue²,

Ouattara³

2011

Anesthesiology

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“…A recent report suggests that PaO 2 during TLV may be the only intraoperative variable that can predict PaO 2 during OLV; a positive relationship exists between these two variables. 13 However, the PaO 2 in our patient with RB-ILD decreased from 500 mmHg during TLV down to 50 mmHg upon initiation of OLV, despite adequate ventilation of the dependent lung with 100% O 2 . This hypoxemia may be attributed to excessive shunting in the non-ventilated lung.…”

Section: éLéments Cliniquescontrasting

confidence: 52%

Alarming hypoxemia during one-lung ventilation in a patient with respiratory bronchiolitis-associated interstitial lung disease

Baraka

Taha

Yaacoub

2003

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : To report a patient with respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) who developed severe hypoxemia during one-lung ventilation (OLV).C Cl li in ni ic ca al l f fe ea at tu ur re es s: : A 27-yr-old female, ex-smoker presented with productive cough and dyspnea of 18-month duration. The chest xray revealed diffuse abnormalities involving both lungs consisting of interstitial emphysema with irregular shadowing. Preoperative PaO 2 was 88 mmHg and pulmonary function tests showed moderate obstructive disease. The patient underwent right open lung biopsy. After induction of anesthesia, a left double lumen tube was inserted and its position verified with auscultation and fibreoptic bronchoscopy. Upon initiation of OLV, the patient developed severe hypoxemia and the PaO 2 dropped from 500 mmHg during twolung ventilation (TLV) to 50 mmHg. Hypoxemia was readily corrected by resuming TLV.C Co on nc cl lu us si io on n: : The severe hypoxemia during OLV in this patient with RB-ILD may be attributed to impaired hypoxic pulmonary vasoconstriction. Other causes were not excluded. Caution is warranted when initiating OLV in these patients.

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“…However, we believe our model is clinically relevant, because the changes observed in oxygenation in the control group closely resemble those seen in a previous clinical study. 21 BVV has previously been applied successfully during the perioperative period, 5 and we would not anticipate undue technical difficulties in using a BVV strategy in patients undergoing thoracotomy in future clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Biologically Variable Ventilation Improves Oxygenation and Respiratory Mechanics during One-lung Ventilation

McMullen

Girling²,

Graham

et al. 2006

Anesthesiology

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Background: Hypoxemia is common during one-lung ventilation (OLV). Atelectasis contributes to the problem. Biologically variable ventilation (BVV), using microprocessors to reinstitute physiologic variability to respiratory rate and tidal volume, has been shown to be advantageous over conventional monotonous control mode ventilation (CMV) in improving oxygenation during the period of lung reinflation after OLV in an experimental model. Here, using a porcine model, the authors compared BVV with CMV during OLV to assess gas exchange and respiratory mechanics.Methods: Eight pigs (25-30 kg) were studied in each of two groups. After induction of anesthesia-tidal volume 12 ml/kg with CMV and surgical intervention-tidal volume was reduced to 9 ml/kg. OLV was initiated with an endobronchial blocker, and the animals were randomly allocated to either continue CMV or switch to BVV for 90 min. After OLV, a recruitment maneuver was undertaken, and both lungs were ventilated for a further 60 min. At predetermined intervals, hemodynamics, respiratory gases (arterial, venous, and end-tidal samples) and mechanics (airway pressures, static and dynamic compliances) were measured. Derived indices (pulmonary vascular resistance, shunt fraction, and dead space ventilation) were calculated.Results: By 15 min of OLV, arterial oxygen tension was greater in the BVV group (group ؋ time interaction, P ‫؍‬ 0.003), and shunt fraction was lower with BVV from 30 to 90 min (group effect, P ‫؍‬ 0.0004). From 60 to 90 min, arterial carbon dioxide tension was lower with BVV (group ؋ time interaction, P ‫؍‬ 0.0001) and dead space ventilation was less from 60 to 90 min (group ؋ time interaction, P ‫؍‬ 0.0001). Static compliance was greater by 60 min of BVV and remained greater during return to ventilation of both lungs (group effect, P ‫؍‬ 0.0001).Conclusions: In this model of OLV, BVV resulted in superior gas exchange and respiratory mechanics when compared with CMV. Improved static compliance persisted with restoration of two-lung ventilation.

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Prediction of arterial oxygen tension during one-lung ventilation: Analysis of preoperative and intraoperative variables

Cited by 47 publications

References 11 publications

Pharmacological Treatment of Hypoxemia during One-lung Ventilation

Pharmacological Treatment of Hypoxemia during One-lung Ventilation

Alarming hypoxemia during one-lung ventilation in a patient with respiratory bronchiolitis-associated interstitial lung disease

Biologically Variable Ventilation Improves Oxygenation and Respiratory Mechanics during One-lung Ventilation

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