E. Cohen et Jb. Eisenkraft, POSITIVE END-EXPIRATORY PRESSURE DURING ONE-LUNG VENTILATION IMPROVESOXYGENATION IN PATIENTS WITH LOW ARTERIAL OXYGEN-TENSIONS, Journal of cardiothoracic and vascular anesthesia, 10(5), 1996, pp. 578-582
Citations number
20
Categorie Soggetti
Anesthesiology,"Peripheal Vascular Diseas","Cardiac & Cardiovascular System
Objective: The application of 10 cm H2O of positive end-expiratory pre
ssure (PEEP(10)) to the ventilated lung during one-lung ventilation (O
LV) has an unpredictable effect on PaO2. It was hypothesized that pati
ents with a low PaO2 (<80 mmHg) during OLV may benefit from applicatio
n of PEEP. Design: Prospective, open. Setting: A university medical ce
nter. Participants: Eighteen patients were studied who were undergoing
OLV for pulmonary resection. All were anesthetized with thiamylal, N2
O/O-2 (50%/50%), isoflurane, and pancuronium. Interventions: Applicati
on of PEEP(10) during one-lung ventilation. Measurements and Main Resu
lts: Hemodynamics and oxygenation were measured during two-lung ventil
ation in the lateral position, OLV, and OLV plus application of PEEP(1
0). Overall, PEEP(10) during OLV failed to produce significant changes
in PaO2, Qs/Qt%, cardiac output (CO), SvO(2), or mean arterial pressu
re. However, in 11 patients whose PaO2 was less than 80 mmHg during OL
V, application of PEEP(10) significantly increased PaO2, decreased Qs/
Qt%, and decreased CO (p < 0.05). In the 7 patients whose PaO2 was gre
ater than 80 mmHg on OLV, the authors did not find a significant effec
t of PEEP(10) on the hemodynamic or oxygenation parameters measured. C
onclusions: In patients with a low PaO2 (<80 mmHg) during OLV with F1O
2 = 0.5, PaO2 is increased by the application of PEEP(10). This maneuv
er may be useful in situations in which application of continuous posi
tive airway pressure (CPAP) to the nonventilated lung is not possible.
Copyright (C) 1996 ny W.B. Saunders Company