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Related Experiment Videos

"Best" PEEP during one-lung ventilation

S Inomata1, T Nishikawa, S Saito

  • 1Department of Anaesthesiology, University of Tsukuba, Ibaraki, Japan.

British Journal of Anaesthesia
|June 1, 1997
PubMed
Summary
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Intrinsic positive end-expired pressure (PEEPi) appears during one-lung ventilation (OLV). Applying PEEP equal to PEEPi improves oxygenation and delivery during OLV, unlike higher PEEP levels.

Area of Science:

  • Anesthesiology
  • Respiratory Physiology
  • Thoracic Surgery

Background:

  • One-lung ventilation (OLV) is used in thoracic surgery, often leading to impaired gas exchange.
  • Intrinsic positive end-expired pressure (PEEPi) can develop during OLV, potentially affecting lung mechanics and oxygenation.
  • Optimizing PEEP during OLV is crucial for maintaining adequate oxygen delivery and hemodynamic stability.

Purpose of the Study:

  • To investigate the occurrence and magnitude of PEEPi during OLV in patients undergoing pulmonary lobectomy.
  • To evaluate the effects of applying external PEEP equal to measured PEEPi on arterial oxygenation, hemodynamics, and oxygen delivery compared to ZEEP and higher PEEP levels.

Main Methods:

  • Eight patients undergoing elective pulmonary lobectomy under general anesthesia were studied.

Related Experiment Videos

  • PEEPi was measured during two-lung ventilation (TLV) and OLV using airway occlusion.
  • External PEEP levels tested were ZEEP, PEEPi, and PEEPi + 5 cm H2O.

    • Main Results:

    • No PEEPi was observed during TLV, but 2-6 mm Hg of PEEPi emerged during OLV.
    • Applying external PEEP equal to PEEPi significantly reduced venous admixture and increased PaO2 without compromising cardiac index.
    • Increasing external PEEP to PEEPi + 5 cm H2O negated the gas exchange benefits and reduced cardiac output.

    Conclusions:

    • Intrinsic positive end-expired pressure (PEEPi) is present during OLV in this patient group.
    • Applying external PEEP tailored to the individual's PEEPi optimizes oxygenation and delivery during OLV.
    • Higher levels of PEEP above the measured PEEPi can be detrimental to hemodynamic function and oxygen delivery.