The Effect of Different I:E Ratio on Gas Exchange of Patients Undergoing One-lung Ventilation for Lung Surgery

Samsung Medical Center110 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Masking

DOUBLE

Enrollment

110

Conditions

Lung Cancer One Lung Ventilation

Eligibility

Sex: ALLMin age: 20 YearsMax age: 70 Years

Medical Language ↔ Plain English

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

Outcomes

Primary Outcomes

arterial CO2 partial pressure

arteial CO2 partial pressure

Time frame: 10 minutes after induction of general anesthesia

arterial CO2 partial pressure

arteial CO2 partial pressure

Time frame: 30 minutes after start of one-lung ventilation

arterial CO2 partial pressure

arteial CO2 partial pressure

Time frame: 60 minutes after start of one-lung ventilation

arterial CO2 partial pressure

arteial CO2 partial pressure

Time frame: 15 min after restart of TLV

arterial CO2 partial pressure

arteial CO2 partial pressure

Time frame: 1 hour after the end of surgery

Secondary Outcomes

arterial O2 partial pressure

Time frame: 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

Mean airway pressure