Lung recruitment improves the efficiency of ventilation and gas exchange during one-lung ventilation anesthesia

Atelectasis in the dependent lung during one-lung ventilation (OLV) impairs arterial oxygenation and increases dead space. We studied the effect of an alveolar recruitment strategy (ARS) on gas exchange and lung efficiency during OLV by using the single-breath test of CO(2) (SBT-CO(2)). Twelve patients undergoing thoracic surgery were studied at three points in time: (a) during two-lung ventilation and (b) during OLV before and (c) after an ARS. The ARS was applied selectively to the dependent lung and consisted of an increase in peak inspiratory pressure up to 40 cm H(2)O combined with a peak end-expiratory pressure level of 20 cm H(2)O for 10 consecutive breaths. The ARS took approximately 3 min. Arterial blood gases, SBT-CO(2), and metabolic and hemodynamic variables were recorded at the end of each study period. Arterial oxygenation and dead space were better during two-lung ventilation compared with OLV. PaO(2) increased during OLV after lung recruitment (244 +/- 89 mm Hg) when compared with OLV without recruitment (144 +/- 73 mm Hg; P < 0.001). The SBT-CO(2) analysis showed a significant decrease in dead-space variables and an increase in the variables related to the efficiency of ventilation during OLV after an ARS when compared with OLV alone. In conclusion, ARS improves gas exchange and ventilation efficiency during OLV.

In this article, we showed how a pulmonary ventilatory maneuver performed in the dependent lung during one-lung ventilation anesthesia improved arterial oxygenation and dead space.