One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study

作者：Kozian A; Schilling T^*; Freden F; Maripuu E; Roecken C; Strang C; Hachenberg T; Hedenstierna G

来源：British Journal of Anaesthesia, 2008, 100(4): 549-559.

DOI：10.1093/bja/aen021

• lung, blood flow
• lung, damage
• surgery, thoracic
• ventilation, one-lung
• ventilation, ventilation-perfusion

Background. One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion ( V, Q). There are no data on the effects of OLV on postoperative <(V)over dot>/<(Q)over dot>. matching. Thus, this controlled study evaluates the influence of OLV on <(V)over dot>/<(Q)over dot>distribution in a pig model using a gamma camera technique [single-photon emission computed tomography (SPECT)] and relates these findings to lung histopathology after OLV.
Methods. Eleven anaesthetized and ventilated pigs (V-T 10 ml kg(-1), FIO2 =0.40, PEEP 5 cm H2O) were studied. After lung separation, OLV and thoracotomy were performed in seven pigs ( OLV group). During OLV and in a two-lung ventilation (TLV), control group (n = 4) ventilation settings remained unchanged. SPECT with Kr-81m ( ventilation) and Tc-99m- labelled macro-aggregated albumin ( perfusion) was performed before, during, and 90 min after OLV/TLV. Finally, lung tissue samples were harvested and examined for alveolar damage.
Results. OLV affected ventilation and haemodynamic variables, but there were no differences between the OLV group and the control group before and after OLV/TLV. SPECT revealed an increase of perfusion in the dependent lung compared with baseline ( 49 - 56%), and a corresponding reduction of perfusion (51 - 44%) in non-dependent lungs after OLV. No perfusion changes were observed in the control group. This resulted in increased low <(V)over dot>/<(Q)over dot> regions and a shift of <(V)over dot>/<(Q)over dot> areas to 0.3 - 0.5 (10(-0.5) - 10(-0.3)) in dependent lungs of OLV pigs and was associated with an increased diffuse alveolar damage score.
Conclusions. OLV in pigs results in a substantial <(V)over dot>/<(Q)over dot> mismatch, hyperperfusion, and alveolar damage in the dependent lung and may thus contribute to gas exchange impairment after thoracic surgery.

• 出版日期2008-4
• 单位河北医科大学