uu.seUppsala University Publications
Change search
ReferencesLink to record
Permanent link

Direct link
One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Physiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Avdelningen för sjukhusfysik.
Show others and affiliations
2008 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 100, no 4, 549-559 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion (V, Q). There are no data on the effects of OLV on postoperative V/Q matching. Thus, this controlled study evaluates the influence of OLV on V/Q distribution in a pig model using a gamma camera technique [single-photon emission computed tomography (SPECT)] and relates these findings to lung histopathology after OLV. METHODS: Eleven anaesthetized and ventilated pigs (V(T)=10 ml kg(-1), Fio2=0.40, PEEP=5 cm H2O) were studied. After lung separation, OLV and thoracotomy were performed in seven pigs (OLV group). During OLV and in a two-lung ventilation (TLV), control group (n=4) ventilation settings remained unchanged. SPECT with (81m)Kr (ventilation) and (99m)Tc-labelled macro-aggregated albumin (perfusion) was performed before, during, and 90 min after OLV/TLV. Finally, lung tissue samples were harvested and examined for alveolar damage. RESULTS: OLV affected ventilation and haemodynamic variables, but there were no differences between the OLV group and the control group before and after OLV/TLV. SPECT revealed an increase of perfusion in the dependent lung compared with baseline (49-56%), and a corresponding reduction of perfusion (51-44%) in non-dependent lungs after OLV. No perfusion changes were observed in the control group. This resulted in increased low V/Q regions and a shift of V/Q areas to 0.3-0.5 (10(-0.5)-10(-0.3)) in dependent lungs of OLV pigs and was associated with an increased diffuse alveolar damage score. CONCLUSIONS: OLV in pigs results in a substantial V/Q mismatch, hyperperfusion, and alveolar damage in the dependent lung and may thus contribute to gas exchange impairment after thoracic surgery.

Place, publisher, year, edition, pages
2008. Vol. 100, no 4, 549-559 p.
Keyword [en]
lung; blood flow, lung; damage, surgery; thoracic, ventilation; one-lung, ventilation, ventilation-perfusion
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-108827DOI: 10.1093/bja/aen021ISI: 000254954900021PubMedID: 18308740OAI: oai:DiVA.org:uu-108827DiVA: diva2:241323
Available from: 2009-10-02 Created: 2009-09-30 Last updated: 2010-05-31Bibliographically approved
In thesis
1. Pathophysiological and Histomorphological Effects of One-Lung Ventilation in the Porcine Lung
Open this publication in new window or tab >>Pathophysiological and Histomorphological Effects of One-Lung Ventilation in the Porcine Lung
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Thoracic surgical procedures require partial or complete airway separation and the opportunity to exclude one lung from ventilation (one-lung ventilation, OLV). OLV is commonly associated with profound pathophysiological changes that may affect the postoperative outcome. It is injurious in terms of increased mechanical stress including alveolar cell stretch and overdistension, shear forces secondary to repeated tidal collapse and reopening of alveolar units and compression of alveolar vessels. Ventilation and perfusion distribution may thus be affected during and after OLV. The present studies investigated the influence of OLV on ventilation and perfusion distribution, on the gas/tissue distribution and on the lung histomorphology in a pig model of thoracic surgery.

Anaesthetised and mechanically ventilated piglets were examined. The ventilation and perfusion distribution within the lungs was assessed by single photon emission computed tomography. Computed tomography was used to establish the effects of OLV on dependent lung gas/tissue distribution. The pulmonary histopathology of pigs undergoing OLV and thoracic surgery was compared with that of two-lung ventilation (TLV) and spontaneous breathing.

OLV induced hyperperfusion and significant V/Q mismatch in the ventilated lung persistent in the postoperative course. It increased cyclic tidal recruitment that was associated with a persistent increase of gas content in the ventilated lung. OLV and thoracic surgery as well resulted in alveolar damage.  In the present model of OLV and thoracic surgery, alveolar recruitment manoeuvre (ARM) and protective ventilation approach using low tidal volume preserved the ventilated lung density distribution and did not aggravate cyclic recruitment of alveoli in the ventilated lung.

In conclusion, the present model established significant alveolar damage in response to OLV and thoracic surgery. Lung injury could be related to the profound pathophysiological consequences of OLV including hyperperfusion, ventilation/perfusion mismatch and increased tidal recruitment of lung tissue in the dependent, ventilated lung.  These mechanisms may contribute to the increased susceptibility for respiratory complications in patients undergoing thoracic surgery. A protective approach including sufficient ARM, application of PEEP, and the use of lower tidal volumes may prevent the ventilated lung from deleterious consequences of OLV.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 54 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 493
Alveolar Recruitment Manoeuvre, One-Lung Ventilation, Lung Protective Ventilation, Tidal Volume, Computed Tomography, Tidal Recruitment, Animal Model, Open Thoracic Surgery, Ventilation/ Perfusion Distribution, Single Photon Emission Computed Tomography, Diffuse Alveolar Damage
National Category
Biomedical Laboratory Science/Technology
Research subject
urn:nbn:se:uu:diva-108850 (URN)978-91-554-7647-2 (ISBN)
Public defence
2009-12-09, Enghoffsalen, Akademiska sjukhuset, 751 85 Uppsala, Ing. 50, 13:15 (English)
Available from: 2009-11-19 Created: 2009-09-30 Last updated: 2009-11-19Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full textPubMed
By organisation
Clinical PhysiologyAnaesthesiology and Intensive CareAvdelningen för sjukhusfysik
In the same journal
British Journal of Anaesthesia
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

Altmetric score

Total: 344 hits
ReferencesLink to record
Permanent link

Direct link