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Controlled hypercapnia during one-lung ventilation in patients undergoing pulmonary resection
J Sticher1, M Müller, S Scholz
1Department of Anaesthesiology and Intensive Care Medicine, Justus-Liebig-University, Giessen, Germany.
Acta Anaesthesiologica Scandinavica
|July 27, 2001
Summary
This pilot study found that hypercapnic one-lung ventilation (OLV-H) during thoracic surgery increased cardiac index and pulmonary vascular resistance but did not alter pulmonary oxygenation. Patients tolerated OLV-H well, with further research needed on oxygenation determinants.
Area of Science:
- Anesthesiology
- Cardiopulmonary Physiology
- Thoracic Surgery
Background:
- Investigated hemodynamic and gas exchange effects of acute hypercapnia during one-lung ventilation (OLV) in thoracotomy patients.
- Compared normocapnic OLV (OLV-N) with hypercapnic OLV (OLV-H) in 14 patients undergoing pulmonary lobectomy.
Purpose of the Study:
- To assess the physiological impact of OLV-H on hemodynamics and gas exchange.
- To compare OLV-H with OLV-N in a surgical context.
Main Methods:
- Hypercapnia induced by reducing tidal volume to achieve PaCO2 of 8-9 kPa.
- Minute ventilation decreased significantly during OLV (from 8.8 to 4.2 L/min).
Main Results:
- Cardiac index increased (3.3 to 3.9 L/min, P<0.01) and pulmonary vascular resistance index rose (245 to 347 dyn s cm(-5) m(-2), P<0.05) during OLV-H.
- Systemic vascular resistance index decreased (1952 to 1636 dyn s cm(-5) m(-2), P<0.01) with no change in pulmonary oxygenation.
Conclusions:
- Hypercapnic one-lung ventilation was well-tolerated by all patients during lobectomy.
- Determinants of pulmonary oxygenation during OLV-H require further investigation.