The Use of Air in the Inspired Gas Mixture During Two-Lung Ventilation Delays Lung Collapse During One-Lung Ventilation

Ko, Raynauld; McRae, Karen; Darling, Gail; Waddell, Thomas K.; McGlade, Desmond; Cheung, Kenneth M.C.; Katz, Joel; Slinger, Peter

doi:10.1213/ane.0b013e318195415f

Cited by 58 publications

(59 citation statements)

References 15 publications

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“…Anesthesia was maintained with target-controlled infusion (TCI) of propofol at an effectsite concentration (Ce) of 3-4 μg/mL, TCI of remifentanil at a Ce of 3-6 ng/mL and cisatracurium infusion at a rate of 0.1 mg·kg −1 ·h −1 . After tracheal intubation, patients received a mixture of 40% O 2 and 60% N 2 O until the start of OLV (2). Tidal volume was 6-8 mL/kg ideal body weight during mechanical two-lung ventilation (2LV) and OLV without positive end-expiratory pressure (5).…”

Section: Methodsmentioning

confidence: 99%

“…The operating surgeon evaluated the degree of lung collapse at 1, 5 and 10 min after the start of OLV using a 10-point visual analogue scale (2). A score of 0 indicates a fully inflated lung; a score of 10 indicates complete lung collapse.…”

Section: Methodsmentioning

confidence: 99%

“…Suction was performed at −30 cmH 2 O during the first minute of OLV. A parallel control arm was left to undergo spontaneous lung collapse.…”

Section: Original Articlementioning

confidence: 99%

“…Nitrous oxide can accelerate phase II collapse, while air may impede it (2). Studies of phase I collapse, such as the disconnection technique (3) and continuous bronchial suction (4), were all performed in the presence…”

Section: Introductionmentioning

confidence: 99%

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Bronchial suction does not facilitate lung collapse when using a double-lumen tube during video-assisted thoracoscopic surgery: a randomized controlled trial

Quan¹,

Yi²,

Huang³

et al. 2017

J. Thorac. Dis.

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Background: Bronchial suction through the lumen of a bronchial blocker has been reported to accelerate lung collapse. The aim of the current study was to examine whether bronchial suction could also facilitate lung collapse when using a double-lumen tube (DLT). Methods: Eighty patients scheduled for elective video-assisted thoracoscopic surgery for lung cancer using a DLT for one-lung ventilation (OLV) were randomised into an arm that received bronchial suction and an arm that underwent spontaneous collapse (n=40 per arm). For bronchial suction, a pressure of −30 cmH 2 O was applied to the lumen of the non-ventilated lung during the first minute of OLV. The primary endpoint was the degree of lung collapse at 10 min after the start of OLV, assessed on a 10-point visual analogue scale (0: fully inflated; 10: complete collapse). Secondary outcomes included lung collapse at 1 and 5 min after the start of OLV, as well as occurrence of intraoperative hypoxemia. Results: Median (interquartile range) lung collapse scores at 10 min were statistically greater in the bronchial suction arm than in the spontaneous collapse arm [9.0 (9.0-9.0) vs. 8.5 (8.0-9.0); P=0.004]. Lung collapse was also statistically greater in the bronchial suction arm at 5 min [8.0 (7.0-8.0) vs. 7.0 (6.25-7.0 J Thorac Dis 2017;9(12):5244-5248 jtd.amegroups.com of a bronchial blocker. As bronchial suction through the lumen of the bronchial blocker offers an effective means of accelerating lung collapse (4), we hypothesized that bronchial suction could also facilitate lung collapse when using a double-lumen tube (DLT).Therefore, we carried out a randomized study to examine the effects of bronchial suction on lung collapse in patients intubated with a DLT. Suction was performed at −30 cmH 2 O during the first minute of OLV. A parallel control arm was left to undergo spontaneous lung collapse. MethodsThe study protocol was approved by the Ethics Committee of Peking Union Medical College Hospital (No. ZS-838) and the authors had followed the applicable Equator guidelines. Written informed consent was obtained from all participants. Clinical trial registration was performed at http://www.chictr.org.cn (identifier: ChiCTR-ICR-15006449) on May 27, 2015. From May 2015 to July 2015, we considered patients for inclusion in our study if they had lung cancer, were scheduled for elective videoassisted thoracoscopic surgery under general anesthesia, underwent OLV using a DLT, had an American Society of Anesthesiologists (ASA) physical status of I-III and were aged 18-75 years. We excluded patients with chronic obstructive pulmonary disease (COPD), pneumothorax, pleural adhesion, early branching of the right upper lobe bronchus (4), anticipated difficult intubation (Mallampatti score ≥3), previous thoracic surgery, or bullae on chest radiographs. Patients were also excluded if their forced expiratory volume in 1 second (FEV 1 ) or forced vital capacity (FVC) were less than 50% of normal values.Patients were randomly allocated to a bronchial suction or spontaneous lu...

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Suction was performed at −30 cmH 2 O during the first minute of OLV. A parallel control arm was left to undergo spontaneous lung collapse.…”

Section: Original Articlementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Bronchial suction does not facilitate lung collapse when using a double-lumen tube during video-assisted thoracoscopic surgery: a randomized controlled trial

Quan¹,

Yi²,

Huang³

et al. 2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…Le Bien qu'une F I O 2 élevée puisse prédisposer à une lésion pulmonaire et à l'atélectasie d'absorption, elle prolonge la période d'apnée sécuritaire lors de l'induction et accélère l'affaissement du poumon lors de l'amorce de la VUP. 25 Recommandations…”

Section: Au Début De La Vup Et Au Besoinunclassified

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

Brassard

Lohser

Donati

et al. 2014

Can J Anesth/J Can Anesth

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Principles of Anesthetic Management for Pulmonary Resection

Hartigan

2011

Practical Handbook of Thoracic Anesthesia

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The Use of Air in the Inspired Gas Mixture During Two-Lung Ventilation Delays Lung Collapse During One-Lung Ventilation

Abstract: De-nitrogenation of the lung during 2LV is a useful strategy to improve surgical conditions during OLV. The use of FIO(2) 1.0 or N(2)O/O(2) (FIO(2) 0.4) during 2LV did not have an adverse effect on subsequent oxygenation during OLV.

Cited by 58 publications

References 15 publications

Bronchial suction does not facilitate lung collapse when using a double-lumen tube during video-assisted thoracoscopic surgery: a randomized controlled trial

Bronchial suction does not facilitate lung collapse when using a double-lumen tube during video-assisted thoracoscopic surgery: a randomized controlled trial

Step-by-step clinical management of one-lung ventilation: Continuing Professional Development

Principles of Anesthetic Management for Pulmonary Resection

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