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Anesthesia & Analgesia:
doi: 10.1213/ANE.0000000000000105
General Articles: Research Report

Setting Individualized Positive End-Expiratory Pressure Level with a Positive End-Expiratory Pressure Decrement Trial After a Recruitment Maneuver Improves Oxygenation and Lung Mechanics During One-Lung Ventilation

Ferrando, Carlos MD, PhD*; Mugarra, Ana MD*; Gutierrez, Andrea MD*; Carbonell, Jose Antonio MD*; García, Marisa MD*; Soro, Marina MD, PhD*; Tusman, Gerardo MD; Belda, Francisco Javier MD, PhD*

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Abstract

BACKGROUND: We investigated whether individualized positive end-expiratory pressure (PEEP) improves oxygenation, ventilation, and lung mechanics during one-lung ventilation compared with standardized PEEP.

METHODS: Thirty patients undergoing thoracic surgery were randomly allocated to the study or control group. Both groups received an alveolar recruitment maneuver at the beginning and end of one-lung ventilation. After the alveolar recruitment maneuver, the control group had their lungs ventilated with a 5 cm·H2O PEEP, while the study group had their lungs ventilated with an individualized PEEP level determined by a PEEP decrement trial. Arterial blood samples, lung mechanics, and volumetric capnography were recorded at multiple timepoints throughout the procedure.

RESULTS: The individualized PEEP values in study group were higher than the standardized PEEP values (10 ± 2 vs 5 cm·H2O; P < 0.001). In both groups, arterial oxygenation decreased when bilateral-lung ventilation was switched to one-lung ventilation and increased after the alveolar recruitment maneuver. During one-lung ventilation, oxygenation was maintained in the study group but decreased in the control group. After one-lung ventilation, arterial oxygenation was significantly higher in the study group (306 vs 231 mm·Hg, P = 0.007). Static compliance decreased in both groups when bilateral-lung ventilation was switched to one-lung ventilation. Static compliance increased significantly only in the study group (P < 0.001) after the alveolar recruitment maneuver and optimal PEEP adjustment. The alveolar recruitment maneuver did not decrease cardiac index in any patient.

CONCLUSIONS: During one-lung ventilation, the improvements in oxygenation and lung mechanics after an alveolar recruitment maneuver were better preserved by ventilation by using individualized PEEP with a PEEP decrement trial than with a standardized 5 cm·H2O of PEEP.

© 2014 International Anesthesia Research Society

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