A randomized comparison of different ventilator strategies during thoracotomy for pulmonary resection

详细信息    查看全文

• 作者：Andrew D. Maslow ; MD^a ; Todd S. Stafford ; MD^b ; Kristopher R. Davignon ; MD^a ; Thomas Ng ; MD^b ; ^{tng@usasurg.org}
• 关键词：1 ; 10.4
• 刊名：The Journal of Thoracic and Cardiovascular Surgery
• 出版年：2013
• 出版时间：July, 2013
• 年：2013
• 卷：146
• 期：1
• 页码：38-44
• 全文大小：277 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Objective

Protective lung ventilation is reported to benefit patients with acute respiratory distress syndrome. It is not known whether protective lung ventilation is also beneficial to patients undergoing single-lung ventilation for elective pulmonary resection.

Methods

In an institutional review board-approved prospective randomized trial, 34 patients undergoing elective pulmonary resection requiring single-lung ventilation were enrolled. Informed consent was obtained. Patients were randomized to 1 of 2 groups: (1) high tidal volume (Hi-TV) of 10 mL/kg, rate of 7 breaths/min, and zero positive end-expiratory pressure or (2) low tidal volume (Lo-TV) of 5 mL/kg, rate of 14 breaths/min, and 5 cmH₂O positive end-expiratory pressure. Ventilator settings were continued during both double- and single-lung ventilation. Pulmonary functions, hemodynamics, and postoperative outcomes were recorded.

Results

Patient demographics, operative characteristics, intraoperative hemodynamics, and postoperative pain and sedation scores were similar between the 2 groups. During most time periods, airway pressures (peak and plateau) were significantly higher in the Hi-TV group; however, plateau pressures remained less than 30 cmH₂O at all times for all patients. The Hi-TV group had significantly lower arterial carbon dioxide tension, less arterial carbon dioxide tension-end-tidal carbon dioxide gradient, lower alveolar dead space ratio, and higher dynamic pulmonary compliance. There were no differences in postoperative morbidity and hospital days between the 2?groups, but atelectasis scores on postoperative days 1 and 2 were lower in the Hi-TV group.

Conclusions

The use of Hi-TV during single-lung ventilation for pulmonary resection resulted in no increase in morbidity and was associated with less hypercarbia, less dead space ventilation, better dynamic compliance, and less postoperative atelectasis.