"Best" PEEP during one-lung ventilation |
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Authors: | Inomata S; Nishikawa T; Saito S; Kihara S |
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Institution: | Department of Anaesthesiology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Ibaraki 305, Japan |
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Abstract: | Eight patients were studied under general anaesthesia for elective
pulmonary lobectomy to see if intrinsic positive end-expired pressure
(PEEPi) would appear or increase in the dependent lung during one-lung
ventilation (OLV) or if application of external PEEP equal to individually
measured PEEPi would produce better arterial oxygenation, haemodynamic
state and oxygen delivery than either zero PEEP (ZEEP) or an external PEEP
5 cm H2O greater than PEEPi. Patients were non-obese, without obstructive
airways disease, aged 53-76 yr and ASA < III. They received standardized
anaesthesia with fentanyl, 50% nitrous oxide in oxygen and isoflurane;
monitoring included radial and fibreoptic pulmonary arterial catheters and
intermittent positive pressure ventilation with a tidal volume of 8 ml
kg-1, 16 bpm, and an I:E ratio of 1:2. PEEPi was measured during two-lung
ventilation (TLV) and OLV, using rapid airway occlusion at end-expiration.
There was no PEEPi during TLV, but 2-6 mm Hg of PEEPi appeared during OLV.
Applying external PEEP equal to individually measured PEEPi reduced venous
admixture and increased PaO2 without a decrease in cardiac index (thus
increasing oxygen delivery) compared with ZEEP, but the improvement in
pulmonary gas exchange was lost and an additional penalty of reduced
cardiac output was imposed when external PEEP was increased to 5 mm Hg
above PEEPi.
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