Lung isolation, one-lung ventilation and hypoxaemia during lung isolation

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Lung isolation is being used more frequently in both adult and paediatric age groups due to increasing incidence of thoracoscopy and video-assisted thoracoscopic surgery in these patients. Various indications for lung isolation and one-lung ventilation include surgical and non-surgical reasons. Isolation can be achieved by double-lumen endotracheal tubes or bronchial blocker. Different issues arise in prone and semi-prone position. The management of hypoxia with lung isolation is a stepwise drill of adding inhaled oxygen, adding positive end-expiratory pressure to ventilated lung and continuous positive airway pressure to non-ventilated side.

Related collections

Most cited references 57

Record: found
Abstract: found
Article: found

Is Open Access

Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial

Rogier Determann, Annick ANM Royakkers, Esther Wolthuis … (2010)

Introduction Recent cohort studies have identified the use of large tidal volumes as a major risk factor for development of lung injury in mechanically ventilated patients without acute lung injury (ALI). We compared the effect of conventional with lower tidal volumes on pulmonary inflammation and development of lung injury in critically ill patients without ALI at the onset of mechanical ventilation. Methods We performed a randomized controlled nonblinded preventive trial comparing mechanical ventilation with tidal volumes of 10 ml versus 6 ml per kilogram of predicted body weight in critically ill patients without ALI at the onset of mechanical ventilation. The primary end point was cytokine levels in bronchoalveolar lavage fluid and plasma during mechanical ventilation. The secondary end point was the development of lung injury, as determined by consensus criteria for ALI, duration of mechanical ventilation, and mortality. Results One hundred fifty patients (74 conventional versus 76 lower tidal volume) were enrolled and analyzed. No differences were observed in lavage fluid cytokine levels at baseline between the randomization groups. Plasma interleukin-6 (IL-6) levels decreased significantly more strongly in the lower-tidal-volume group ((from 51 (20 to 182) ng/ml to 11 (5 to 20) ng/ml versus 50 (21 to 122) ng/ml to 21 (20 to 77) ng/ml; P = 0.01)). The trial was stopped prematurely for safety reasons because the development of lung injury was higher in the conventional tidal-volume group as compared with the lower tidal-volume group (13.5% versus 2.6%; P = 0.01). Univariate analysis showed statistical relations between baseline lung-injury score, randomization group, level of positive end-expiratory pressure (PEEP), the number of transfused blood products, the presence of a risk factor for ALI, and baseline IL-6 lavage fluid levels and the development of lung injury. Multivariate analysis revealed the randomization group and the level of PEEP as independent predictors of the development of lung injury. Conclusions Mechanical ventilation with conventional tidal volumes is associated with sustained cytokine production, as measured in plasma. Our data suggest that mechanical ventilation with conventional tidal volumes contributes to the development of lung injury in patients without ALI at the onset of mechanical ventilation. Trial registration ISRCTN82533884

0 comments Cited 134 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Hypoxemia during one-lung ventilation: prediction, prevention, and treatment.

W Karzai, Konrad Schwarzkopf (2009)

When switching from two-lung to one-lung ventilation (OLV), shunt fraction increases, oxygenation is impaired, and hypoxemia may occur. Hypoxemia during OLV may be predicted from measurements of lung function, distribution of perfusion between the lungs, whether the right or the left lung is ventilated, and whether the operation will be performed in the supine or in the lateral decubitus position. Hypoxemia during OLV may be prevented by applying a ventilation strategy that avoids alveolar collapse while minimally impairing perfusion of the dependent lung. Choice of anesthesia does not influence oxygenation during clinical OLV. Hypoxemia during OLV may be treated symptomatically by increasing inspired fraction of oxygen, by ventilating, or by using continuous positive airway pressure in the nonventilated lung. Hypoxemia during OLV may be treated causally by correcting the position of the double-lumen tube, clearing the main bronchi of the ventilated lung from secretions, and improving the ventilation strategy.

0 comments Cited 86 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: not found
Article: not found

Inhaled nitric oxide: a selective pulmonary vasodilator: current uses and therapeutic potential.

Warren M. Zapol, Fumito Ichinose, J. Roberts (2004)

0 comments Cited 68 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Journal

Journal ID (nlm-ta): Indian J Anaesth

Journal ID (iso-abbrev): Indian J Anaesth

Journal ID (publisher-id): IJA

Title: Indian Journal of Anaesthesia

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0019-5049

ISSN (Electronic): 0976-2817

Publication date (Print): September 2015

Volume: 59

Issue: 9

Pages: 606-617

Affiliations

[1]Department of Anaesthesiology, SIDSS, Santokba Durlabhji Memorial Hospital, Jaipur, Rajasthan, India

[1 ]Department of Anesthesia and Critical Care, Mahatma Gandhi Medical College, Jaipur, Rajasthan, India

[2 ]Department of Anesthesia, SMS Medical College, Jaipur, Rajasthan, India

Author notes

Address for correspondence: Dr. Atul Purohit, C-26, Mukherji Colony, Shastri Nagar, Jaipur - 302 016, Rajasthan, India. E-mail: apurohit66@ 123456yahoo.com

Article

Publisher ID: IJA-59-606

DOI: 10.4103/0019-5049.165855

PMC ID: 4613408

PubMed ID: 26556920

SO-VID: 9b167b69-4c5e-4487-881a-83ca4846f735

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

History

Comments

Comment on this article

scite_

Smart Citations

Citing PublicationsSupportingMentioningContrasting

View Citations

See how this article has been cited at scite.ai

scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.

Lung isolation, one-lung ventilation and hypoxaemia during lung isolation

Read this article at

Abstract

Related collections

Inflamed lung in vitro co-culture models

Most cited references 57

Ventilation with lower tidal volumes as compared with conventional tidal volumes for patients without acute lung injury: a preventive randomized controlled trial

Hypoxemia during one-lung ventilation: prediction, prevention, and treatment.

Inhaled nitric oxide: a selective pulmonary vasodilator: current uses and therapeutic potential.

Author and article information

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 761

Cited by 27

Most referenced authors 368