Peep titration based on the open lung approach during one lung ventilation in thoracic surgery: a physiological study

• DOI: 10.1186/s12871-018-0624-3
• Publication Date: 2018-10-31T18:58:51Z
• Authors: Michela Rauseo; Lucia Mirabella; Salvatore Grasso; Antonella Cotoia; Savino Spadaro; Davide D’Antini; Franca Valentino; Livio Tullo; Domenico Loizzi; Francesco Sollitto; Gilda Cinnella
• Keywords: Transpulmonary pressure; Respiratory physiology; Cardiothoracic surgery; Positive End-Expiratory Pressure; Pulmonary compliance; Peak inspiratory pressure; Plateau pressure

During thoracic surgery in lateral decubitus, one lung ventilation (OLV) may impair respiratory mechanics and gas exchange. We tested a strategy based on an open approach (OLA) consisting recruitment immediately followed by decremental positive-end expiratory pressure (PEEP) titration to the best system compliance (CRS) separately quantified elastic properties of chest wall. Our hypothesis was that this would improve Further, we were interested documenting impact OLA partitioned mechanics. In thirteen patients undergoing upper left lobectomy studied wall mechanics, transpulmonary (PL), driving (ΔPRS ΔPL), exchange hemodynamics at two time-points (a) during OLV zero end-expiratory (OLVpre-OLA) (b) after application open-lung (OLVpost-OLA). The external PEEP selected through 6 ± 0.8 cmH2O. As compared OLVpre-OLA, PaO2/FiO2 ratio went from 205 73 313 86 (p = .05) CL increased 56 18 ml/cmH2O 71 12 .0013), without changes CCW. Both ΔPRS ΔPL decreased 9.2 0.4 cmH2O 6.8 0.6 8.1 0.5 5.7 cmH2O, .001 p .015 vs OLVpre-OLA), respectively. Hemodynamic parameters remained stable throughout study period. our patients, performed improved oxygenation had no clinically significant hemodynamic effects. Although not specifically designed ΔPL, observed parallel reduction both OLA. TRN: ClinicalTrials.gov , NCT03435523 retrospectively registered, Feb 14 2018.