A preemptive alveolar recruitment strategy before one-lung ventilation improves arterial oxygenation in patients undergoing thoracic surgery: a prospective randomised study

作者：Park Sang Heon; Jeon Young Tae; Hwang Jung Won; Do Sang Hwan; Kim Ju Hee; Park Hee Pyoung^*

来源：European Journal of Anaesthesiology, 2011, 28(4): 298-302.

DOI：10.1097/EJA.0b013e3283436fdb

• alveolar recruitment strategy
• arterial oxygenation
• one-lung ventilation

Background and objective Arterial hypoxaemia remains a problem during one-lung ventilation (OLV). We determined whether a preemptive alveolar recruitment strategy (ARS) before OLV improves arterial oxygenation during OLV in patients undergoing thoracic surgery.
Methods Forty-two patients were allocated randomly to receive either a tidal volume of 10 ml kg(-1) (group C) or ARS of 10 manual breaths with a peak inspiratory pressure of 40 cmH(2)O followed by positive end-expiratory pressure (PEEP) of 15 cmH(2)O until OLV commenced (group P). The dependent lung was ventilated with a tidal volume of 6 ml kg(-1) and PEEP of 5 cmH(2)O during OLV in both groups. Arterial blood gas data were recorded before ARS (baseline), after 15, 30, 45, 60 min of OLV, and at the end of OLV.
Results Baseline paO(2) in group P was similar to that in group C (29.9 +/- 3.9 vs. 30.0 +/- 3.5 kPa). However, paO(2) was significantly higher in group P than in group C during OLV (38.9 +/- 15.0 vs. 28.8 +/- 14.4 kPa after 15 min of OLV, 39.6 +/- 13.3 vs. 31.2 +/- 13.9 kPa after 60 min of OLV and 45.5 +/- 12.1 vs. 34.3 +/- 12.0 kPa before an air leakage test, P < 0.05). The alveolar-arterial oxygen gradient was significantly lower in group P than in group C after 15 min of OLV and at the end of OLV (46.1 +/- 14.4 vs. 55.9 +/- 14.7, 39.7 +/- 12.4 vs. 50.7 +/- 12.3 kPa, P < 0.05).
Conclusion Preemptive ARS before OLV is effective in improving arterial oxygenation during the entire period of OLV. Eur J Anaesthesiol 2011;28:298-302 Published online 18 January 2011

• 出版日期2011-4