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Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial
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2012 (English)In: British Journal of Anaesthesia, ISSN 0007-0912, E-ISSN 1471-6771, Vol. 108, no 3, 517-524 p.Article in journal (Refereed) Published
Abstract [en]

Background

This study was conducted to determine whether an alveolar recruitment strategy (ARS) applied during two-lung ventilation (TLV) just before starting one-lung ventilation (OLV) improves ventilatory efficiency.

Methods

Subjects were randomly allocated to two groups: (i) control group: ventilation with tidal volume (VT) of 8 or 6 ml kg−1 for TLV and OLV, respectively, and (ii) ARS group: same ventilatory pattern with ARS consisting of 10 consecutive breaths at a plateau pressure of 40 and 20 cm H2O PEEP applied immediately before and after OLV. Volumetric capnography and arterial blood samples were recorded 5 min (baseline) and 20 min into TLV, at 20 and 40 min during OLV, and finally 10 min after re-establishing TLV.

Results

Twenty subjects were included in each group. In all subjects, the airway component of dead space remained constant during the study. Compared with baseline, the alveolar dead space ratio (VDalv/VTalv) increased throughout the protocol in the control but decreased in the ARS group. Differences in VDalv/VTalv between groups were significant (P<0.001). Except for baseline, all PaO2 values in kPa (sd) were higher in the ARS than in the control group (P<0.001), respectively [70 (7) and 55 (9); 33 (9) and 24 (10); 33 (8) and 22 (10); 70 (7) and 55 (10)].

Conclusions

Recruitment of both lungs before instituting OLV not only decreased alveolar dead space but also improved arterial oxygenation and the efficiency of ventilation.

Place, publisher, year, edition, pages
2012. Vol. 108, no 3, 517-524 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-176046DOI: 10.1093/bja/aer415PubMedID: 22201185OAI: oai:DiVA.org:uu-176046DiVA: diva2:534068
Available from: 2012-06-15 Created: 2012-06-15 Last updated: 2017-12-07Bibliographically approved

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