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Ventilation with a low tidal volume vs. an intermediate tidal volume during pleural decortication
Annali Italiani Di Chirurgia
|May 5, 2022
Summary
Low tidal volume and PEEP combined with PCV-VG ventilation improved outcomes during one lung ventilation in patients with tuberculous destroyed lung. This approach reduced airway pressure and intrapulmonary shunt, potentially alleviating pulmonary injury.
Area of Science:
- Anesthesiology and Critical Care Medicine
- Respiratory Physiology
- Thoracic Surgery
Background:
- Tuberculous destroyed lung (TDL) presents unique challenges during thoracic surgery requiring specialized ventilation strategies.
- One lung ventilation (OLV) is essential for thoracic procedures but can lead to lung injury.
- Optimizing ventilation parameters is crucial to minimize complications associated with OLV in TDL patients.
Purpose of the Study:
- To evaluate the efficacy of combining low tidal volume and positive end-expiratory pressure (PEEP) with pressure-controlled ventilation-volume guaranteed (PCV-VG) during OLV in TDL patients.
- To assess the impact of this ventilation strategy on pulmonary injury markers and gas exchange.
- To compare PCV-VG with conventional volume-controlled ventilation (VCV) during OLV in this patient population.
Main Methods:
- Patients with TDL undergoing OLV were divided into two groups: conventional volume-controlled ventilation (VCV) and PCV-VG with PEEP.
- The PCV-VG group received a lower tidal volume (6 ml/kg) and PEEP (7 cm H2O) compared to the VCV group (8 ml/kg).
- Ventilation parameters, airway pressures, oxygenation index (OI), intrapulmonary shunt (Qs/Qt), PaCO2, and inflammatory markers (IL-6, TNF-α, BNP) were monitored.
Main Results:
- The PCV-VG group demonstrated significantly lower peak airway pressure (Ppeak), plateau pressure (Pplat), and intrapulmonary shunt (Qs/Qt) compared to the VCV group.
- Oxygenation index (OI) improved, and Qs/Qt decreased in the PCV-VG group, while PaCO2 increased.
- Concentrations of IL-6, TNF-α, and BNP were reduced in the PCV-VG group post-ventilation.
Conclusions:
- The combination of low tidal volume, PEEP, and PCV-VG ventilation is a beneficial strategy for managing OLV in patients with TDL.
- This approach effectively reduces airway pressures and intrapulmonary shunt, potentially mitigating lung injury during OLV.
- PCV-VG with PEEP offers an improved method for lung protection in TDL patients undergoing thoracic surgery.
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