Year : 2011  |  Volume : 14  |  Issue : 3  |  Page : 183--187

Positive end expiratory pressure during one-lung ventilation: Selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation


Nir Hoftman, Cecilia Canales, Matthew Leduc, Aman Mahajan 
 Department of Anesthesiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA

Correspondence Address:
Aman Mahajan
Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Suite 2331G, Los Angeles, CA
USA

The efficacy of positive end-expiratory pressure (PEEP) in treating intraoperative hypoxemia during one-lung ventilation (OLV) remains in question given conflicting results of prior studies. This study aims to (1) evaluate the efficacy of PEEP during OLV, (2) assess the utility of preoperative predictors of response to PEEP, and (3) explore optimal intraoperative settings that would maximize the effects of PEEP on oxygenation. Forty-one thoracic surgery patients from a single tertiary care university center were prospectively enrolled in this observational study. After induction of general anesthesia, a double-lumen endotracheal tube was fiberoptically positioned and OLV initiated. Intraoperatively, PEEP = 5 and 10 cmH 2 O were sequentially applied to the ventilated lung during OLV. Arterial oxygenation, cardiovascular performance parameters, and proposed perioperative variables that could predict or enhance response to PEEP were analysed. T-test and c2 tests were utilized for continuous and categorical variables, respectively. Multivariate analyses were carried out using a classification tree model of binary recursive partitioning. PEEP improved arterial oxygenation by ≥20% in 29% of patients (n = 12) and failed to do so in 71% (n = 29); however, no cardiovascular impact was noted. Among the proposed clinical predictors, only intraoperative tidal volume per kilogram differed significantly between responders to PEEP and non-responders (mean 6.6 vs. 5.7 ml/kg, P = 0.013); no preoperative variable predicted response to PEEP. A multivariate analysis did not yield a clinically significant model for predicting PEEP responsiveness. PEEP improved oxygenation in a subset of patients; larger, although still protective tidal volumes favored a positive response to PEEP. No preoperative variables, however, could be identified as reliable predictors for PEEP responders.


How to cite this article:
Hoftman N, Canales C, Leduc M, Mahajan A. Positive end expiratory pressure during one-lung ventilation: Selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation.Ann Card Anaesth 2011;14:183-187


How to cite this URL:
Hoftman N, Canales C, Leduc M, Mahajan A. Positive end expiratory pressure during one-lung ventilation: Selecting ideal patients and ventilator settings with the aim of improving arterial oxygenation. Ann Card Anaesth [serial online] 2011 [cited 2020 Sep 22 ];14:183-187
Available from: http://www.annals.in/article.asp?issn=0971-9784;year=2011;volume=14;issue=3;spage=183;epage=187;aulast=Hoftman;type=0