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

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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.

CTSNet classification

1
10.4

Abbreviations and Acronyms

ALI
acute lung injury
ARDS
acute respiratory distress syndrome
CT
computed tomography
ETCO2
end-tidal carbon dioxide
Fio2
inspired oxygen fraction
Hi-TV
high tidal volume (group)
ICU
intensive care unit
Lo-TV
low tidal volume (group)
Paco2
arterial carbon dioxide tension
Pao2
arterial oxygen tension
PEEP
positive end-expiratory pressure
Sao2
arterial oxygen saturation
TV
tidal volume

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Disclosures: Authors have nothing to disclose with regard to commercial support.