The online version of this article (https://doi.org/10.1186/s12871-018-0476-x) contains supplementary material, which is available to authorized users.
The interest in perioperative lung protective ventilation has been increasing. However, optimal management during one-lung ventilation (OLV) remains undetermined, which not only includes tidal volume (VT) and positive end-expiratory pressure (PEEP) but also inspired oxygen fraction (FIO2). We aimed to investigate current practice of intraoperative ventilation during OLV, and analyze whether the intraoperative ventilator settings are associated with postoperative pulmonary complications (PPCs) after thoracic surgery.
We performed a prospective observational two-center study in Japan. Patients scheduled for thoracic surgery with OLV from April to October 2014 were eligible. We recorded ventilator settings (FIO2, VT, driving pressure (ΔP), and PEEP) and calculated the time-weighted average (TWA) of ventilator settings for the first 2 h of OLV. PPCs occurring within 7 days of thoracotomy were investigated. Associations between ventilator settings and the incidence of PPCs were examined by multivariate logistic regression.
We analyzed perioperative information, including preoperative characteristics, ventilator settings, and details of surgery and anesthesia in 197 patients. Pressure control ventilation was utilized in most cases (92%). As an initial setting for OLV, an FIO2 of 1.0 was selected for more than 60% of all patients. Throughout OLV, the median TWA FIO2 of 0.8 (0.65-0.94), VT of 6.1 (5.3-7.0) ml/kg, ΔP of 17 (15-20) cm H2O, and PEEP of 4 (4-5) cm H2O was applied. Incidence rate of PPCs was 25.9%, and FIO2 was independently associated with the occurrence of PPCs in multivariate logistic regression. The adjusted odds ratio per FIO2 increase of 0.1 was 1.30 (95% confidence interval: 1.04-1.65, P = 0.0195).
High FIO2 was applied to the majority of patients during OLV, whereas low VT and slight degree of PEEP were commonly used in our survey. Our findings suggested that a higher FIO2 during OLV could be associated with increased incidence of PPCs.
Additional file 1: Baseline characteristics and intraoperative procedures of all patients. (DOCX 21 kb)12871_2018_476_MOESM1_ESM.docx
Additional file 2: Adjusted odds ratio of TWA FIO2 during OLV for the incidence of PPCs in subgroup analyses. (PPTX 79 kb)12871_2018_476_MOESM2_ESM.pptx
Additional file 3: The correlation between TWA FIO2 and minimum SpO2. (PPTX 84 kb)12871_2018_476_MOESM3_ESM.pptx
Canet J, Mazo V. Postoperative pulmonary complications. Minerva Anestesiol. 2010;76(2):138–43. PubMed
Serpa Neto A, Cardoso SO, Manetta JA, Pereira VG, Espósito DC, Pasqualucci Mde O, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308(16):1651–9. CrossRefPubMed
PROVE Network Investigators for the Clinical Trial Network of the European Society of Anaesthesiology, Hemmes SN, Gama de Abreu M, Pelosi P, Schultz MJ. High versus low positive end-expiratory pressure during general anaesthesia for open abdominal surgery (PROVHILO trial): a multicentre randomised controlled trial. Lancet 2014; 384 (9942):495–503.
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342(18):1301–8. CrossRef
Lohser J, Ishikawa S. Clinical Management of one-Lung Ventilation. In: Slinger P, editor. Principles and practice of anesthesia for thoracic surgery. New York: Springer Science & Business Media; 2011. p. 83–101. CrossRef
Wilson WC, Benumof JL. Anesthesia for thoracic surgery. In: Miller RD, editor. Miller’s anesthesia. 6th ed. Philadelphia: Elsevier Churchill Livingstone; 2005. p. 1847–939.
Kilgannon JH, Jones AE, Parrillo JE, Dellinger RP, Milcarek B, Hunter K, et al. Emergency medicine shock research network (EMShockNet) investigators: relationship between supranormal oxygen tension and outcome after resuscitation from cardiac arrest. Circulation. 2011;123(23):2717–22. CrossRefPubMed
Panwar R, Hardie M, Bellomo R, Barrot L, Eastwood GM, Young PJ, CLOSE Study Investigators and the ANZICS Clinical Trials Group, et al. Conservative versus liberal oxygenation targets for mechanically ventilated patients. A pilot multicenter randomized controlled trial. Am J Respir Crit Care Med. 2016;193(1):43–51. CrossRefPubMed
- Associations between intraoperative ventilator settings during one-lung ventilation and postoperative pulmonary complications: a prospective observational study
- BioMed Central
Neu im Fachgebiet AINS
Meistgelesene Bücher aus dem Fachgebiet AINS
Mail Icon II