Gas Exchange, Inverse-ratio Ventilation, Lung Cancer, One Lung Ventilation
Conditions
Keywords
one lung ventilation, gas exchange, inverse-ratio ventilation
Brief summary
Pulmonary gas exchange disturbance is a common anesthetic problem during one-lung ventilation (OLV) for thoracic surgery. The inverse-ratio ventilation (IRV), which prolongs the inspiratory time greater than expiratory time, can be applied for adult respiratory distress syndrome. The effect of IRV is to improve gas-exchange status by increasing mean airway pressure and alveolar recruitment. We tried to evaluate the effect of IRV during OLV with lung protective strategy.
Detailed description
Pulmonary gas exchange disturbance is a common anesthetic problem during one-lung ventilation (OLV) for thoracic surgery. Continuous positive airway pressure or positive end-expiratory pressure are usually applied to improve this disorder including hypoxia, but these methods are not enough. The inverse-ratio ventilation (IRV), which prolongs the inspiratory time greater than expiratory time, can be applied for adult respiratory distress syndrome. The effect of IRV is to improve gas-exchange status by increasing mean airway pressure and alveolar recruitment. The application of IRV during OLV has not been performed to our knowledge, and there is a possibility of IRV to improve oxygenation during OLV. There is a possibility of increase of auto-PEEP, or air trapping in subjects with chronic obstructive pulmonary disease, but this kind of auto-PEEP can be overcome by external PEEP. Therefore, we tried to evaluate the effect of IRV during OLV with lung protective strategy.
Interventions
conventional I:E ratio of 1:2 is applied. Ventilator : Datex-Ohmeda Aestiva/5 ® model
I:E ratio of 1:1 is applied Ventilator : Datex-Ohmeda Aestiva/5 ® model
Sponsors
Study design
Eligibility
Inclusion criteria
* patients undergoing elective lung lobectomy surgery. * the duration of one-lung ventilation is more than one hour. * subjects with more than twenty years old.
Exclusion criteria
* subjects with past history of pneumothorax, asthma * Age under 20, more than 70 years. * Patients with ischemic heart disease, valvular heart disease * patients with hemodynamic unstability
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| arterial CO2 partial pressure | 10 minutes after induction of general anesthesia | arteial CO2 partial pressure |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| arterial O2 partial pressure | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation, 1 hour after the end of surgery | arterial O2 partial pressure |
| Mean airway pressure | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | Mean airway pressure |
| tidal volume (exhaled) | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | tidal volume (exhaled) |
| hemodynamic parameters | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | systolic/ diastolic blood pressure, heart rate, mean blood pressure |
| end-tidal CO2 partial pressure | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | end-tidal CO2 partial pressure |
| respiratory compliance | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | Dynamic compliance, Static compliance |
| Dead space | 10 min after induction, 30 and 60 min after start of one lung ventilation, 15 min after restart of two-lung ventilation | physiologic dead space / tidal volume (VD/VT) |
| work of breathing | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | work of breathing |
| peak inspiratory pressure | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | peak inspiratory pressure |
| plateau pressure | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | plateau pressure |
| positive end-expiratory pressure | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | positive end-expiratory pressure |
| minute ventilation | 10 min after induction, 30 and 60 min after start of one-lung ventilation, 15 min after restart of two-lung ventilation | minute ventilation |
Countries
South Korea