Comparison between conventional and protective one-lung ventilation for ventilator-assisted thoracic surgery.

Area of Science:

• Anesthesiology
• Thoracic Surgery
• Respiratory Physiology

Background:

• Protective ventilation (PV) is suggested to reduce pulmonary complications during one-lung ventilation (OLV).
• Evidence for PV benefits in patients with normal preoperative lung function undergoing minimally invasive thoracic surgery is inconsistent.

Purpose of the Study:

• To compare conventional OLV with protective OLV in patients with normal preoperative pulmonary function undergoing video-assisted thoracic surgery.
• To evaluate the impact of ventilation strategies on oxygenation, respiratory mechanics, and inflammatory markers.

Main Methods:

• Patients with normal pulmonary function undergoing video-assisted thoracic surgery were randomized to conventional OLV (VT 10 ml/kg, FiO2 1.0, zero PEEP) or protective OLV (VT 6 ml/kg, FiO2 0.5, PEEP 5 cmH2O).
• Measurements included oxygenation (PaO2, PaO2/FiO2), respiratory mechanics, and plasma levels of interleukin-6 and malondialdehyde at baseline, during OLV, and postoperatively.

Main Results:

• Conventional OLV resulted in significantly higher PaO2 and PaO2/FiO2 compared to protective OLV.
• Interleukin-6 and malondialdehyde levels increased in both groups, with no significant difference in the magnitude of increase.
• No significant differences were observed in postoperative PaO2/FiO2 < 300 mmHg or chest radiography abnormalities between the groups.

Conclusions:

• Protective ventilation did not offer advantages over conventional ventilation in patients with normal lung function undergoing video-assisted thoracic surgery.
• Conventional OLV may be a suitable strategy for this patient population, ensuring adequate oxygenation without increased harm.