The impact of lung recruitment on hemodynamics during one-lung ventilation

The objective of the present study was to investigate respiratory and hemodynamic changes by measuring continuous cardiac output, cardiac filling, and stroke volume variation after lung recruitment in thoracic surgery.

A prospective, observational study.

A tertiary care university hospital single institution.

Forty patients undergoing thoracotomy for lung resection with at least 1 hour of one-lung ventilation (OLV).

During OLV, an alveolar recruitment maneuver (ARM) was performed.

Based on Edwards Vigileo/FloTrac system (Edwards Lifesciences, Irvine, CA), the arterial pressure-based cardiac output, cardiac index, systemic vascular resistance, stroke volume variation, and central venous oxygen saturation were recorded immediately before the maneuver and 1, 2, 3, 4, 5, and 10 minutes after the maneuver. Stroke volume variation was the parameter most affected during and after the maneuver; it increased to 50% and 40% in the first and second minute, respectively (p < 0.01). The cardiac index was also affected and decreased 9.4% (p < 0.05) in the first minute after the maneuver. ScvO2 decreased significantly during the first 2 minutes (7% and 6.5%, respectively). However, after 3 minutes, all values recorded were similar to prerecruitment values. The PaO2 and PcvO2 from samples taken 10 minutes after the maneuver improved considerably with respect to the values before alveolar recruitment.

The authors concluded that during open-chest surgery with OLV, an ARM effectively improved oxygenation without inducing important circulatory changes.