The impact of heated humidified circuits on arterial oxygenation during one-lung ventilation in thoracic surgery: a
Sun-Kyung Park1, Jiwon Lee1, Myoung Hwa Kim1
1Department of Anesthesiology and Pain Medicine and Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Purpose:
One-lung ventilation (OLV) during thoracic surgery often disturbs systemic oxygenation. Hypoxic pulmonary vasoconstriction is influenced by body temperature; however, the effect of heated humidified circuits on hypoxic pulmonary vasoconstriction and arterial oxygenation during OLV remains unclear. This study aimed to investigate the impact of heated humidified circuits on arterial oxygenation during OLV for thoracic surgery, compared with conventional non-heated circuits.
Methods:
Patients undergoing video-assisted thoracic surgery were randomly assigned to the heated humidified circuit or conventional breathing circuit group. During two-lung ventilation, tidal volume was set at 8 ml/kg with a fraction of inspired oxygen (FiO2) of 0.5, and during OLV, it was adjusted to 6 ml/kg with a FiO2 of 1.0. Arterial blood gas measurements were obtained preoperatively, during two-lung ventilation, at 15, 30, 45, and 60 min after initiating OLV. The primary outcome was the partial pressure of oxygen in the arterial blood (PaO2) at 30 min after initiating OLV.
Results:
Ninety-seven patients were included in the final analysis. The heated humidified circuit group had significantly higher PaO₂ at 30 min after initiating OLV than the control group (estimated mean [standard error], 211.3 [13.4] vs. 146.2 [13.2] mmHg; P = 0.004). The mean PaO2 at 15 and 45 min was significantly higher in the heated humidified circuit group.
Conclusion:
Using heated humidified circuits significantly improves PaO2 during OLV in patients undergoing thoracic surgery compared to conventional circuits. These findings suggest that heated humidified circuits can be considered as an option when hypoxemia persists despite other interventions.
Related Concept Videos
01:16Oxygen Delivering System II: Venturi Mask and Transtracheal Oxygen
Venturi Mask
The Venturi mask, named after the Venturi effect, is designed to deliver precise oxygen concentrations. It consists of a large tube with an oxygen inlet that narrows down, causing a pressure drop that pulls air in through adjustable side ports. The mask is a lightweight,...
01:16Treatment for Pulmonary Arterial Hypertension: Oxygen Therapy for Respiratory Failure
Oxygen therapy is vital in increasing and maintaining blood oxygen levels in PAH patients. As a result, it aids in reducing fatigue,...
01:23Physiological Control of Respiration
Breathing, a seemingly passive process, is regulated by the respiratory center in the brainstem. This center coordinates the involuntary control of respirations, which means it occurs without conscious effort, ensuring a smooth and uninterrupted pattern.
Regulation of Ventilation
The body maintains ventilation by monitoring levels of carbon dioxide (CO2), oxygen (O2), and hydrogen ion concentration (pH) in the arterial blood. Among these factors, the level of CO2 plays a crucial...
01:23Oxygen Delivering System III: Tracheostomy and T-piece
Tracheostomy
A tracheostomy is a surgically created opening (stoma) in the anterior part of the trachea. It is used to establish a patient airway, bypass an upper airway obstruction, simplify the removal of secretions, permit long-term...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...