Preemptive one lung ventilation enhances lung collapse during thoracoscopic surgery: A randomized controlled trial

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Respiratory Physiology

Background:

• One lung ventilation (OLV) is standard practice during thoracoscopic surgery, typically initiated after pleural opening.
• The timing of OLV initiation may influence the speed of lung collapse and surgical conditions.

Purpose of the Study:

• To compare the efficacy of preemptive OLV versus conventional OLV in achieving lung collapse during thoracoscopic surgery.
• To evaluate the impact of preemptive OLV on lung collapse duration and patient oxygenation.

Main Methods:

• A randomized controlled trial involving 67 patients undergoing thoracoscopic surgery.
• Patients were assigned to either conventional OLV or preemptive OLV, where the double lumen endotracheal tube (DLT) lumen was occluded before pleural opening.
• Lung collapse was assessed using a 10-point rating scale, with duration to a score of 8 as the primary endpoint. Secondary endpoints included PaO2 and hypoxemia.

Main Results:

• Preemptive OLV resulted in a significantly shorter duration to satisfactory lung collapse (9.1 ± 1.2 minutes) compared to conventional OLV (14.1 ± 4.7 minutes; P < 0.01).
• PaO2 levels were comparable at most time points, with a slight, non-clinically significant decrease in the preemptive group immediately after pleural incision.
• No instances of hypoxemia were observed in either group.

Conclusions:

• Preemptive OLV accelerates lung collapse during thoracoscopic procedures.
• This technique offers a safe and effective alternative for optimizing surgical conditions with no increased risk of hypoxemia.