医学
呼气末正压
分流(医疗)
通气灌注不匹配
仰卧位
肺顺应性
麻醉
肺分流
灌注
心脏病学
肺
通风(建筑)
开胸手术
内科学
肺容积
机械通风
血流动力学
机械工程
工程类
作者
Jakob Wittenstein,Martin Scharffenberg,Jonathan Fröhlich,Carolin Rothmann,Xinze Ran,Yingying Zhang,Yusen Chai,Xiuli Yang,Sabine Müller,Thea Koch,Robert Huhle,Marcelo Gama de Abreu
出处
期刊:Anesthesiology
[Ovid Technologies (Wolters Kluwer)]
日期:2024-04-16
卷期号:141 (1): 44-55
标识
DOI:10.1097/aln.0000000000005014
摘要
Background During one-lung ventilation (OLV), positive end-expiratory pressure (PEEP) can improve lung aeration but might overdistend lung units and increase intrapulmonary shunt. The authors hypothesized that higher PEEP shifts pulmonary perfusion from the ventilated to the nonventilated lung, resulting in a U-shaped relationship with intrapulmonary shunt during OLV. Methods In nine anesthetized female pigs, a thoracotomy was performed and intravenous lipopolysaccharide infused to mimic the inflammatory response of thoracic surgery. Animals underwent OLV in supine position with PEEP of 0 cm H2O, 5 cm H2O, titrated to best respiratory system compliance, and 15 cm H2O (PEEP0, PEEP5, PEEPtitr, and PEEP15, respectively, 45 min each, Latin square sequence). Respiratory, hemodynamic, and gas exchange variables were measured. The distributions of perfusion and ventilation were determined by IV fluorescent microspheres and computed tomography, respectively. Results Compared to two-lung ventilation, the driving pressure increased with OLV, irrespective of the PEEP level. During OLV, cardiac output was lower at PEEP15 (5.5 ± 1.5 l/min) than PEEP0 (7.6 ± 3 l/min) and PEEP5 (7.4 ± 2.9 l/min; P = 0.004), while the intrapulmonary shunt was highest at PEEP0 (PEEP0: 48.1% ± 14.4%; PEEP5: 42.4% ± 14.8%; PEEPtitr: 37.8% ± 11.0%; PEEP15: 39.0% ± 10.7%; P = 0.027). The relative perfusion of the ventilated lung did not differ among PEEP levels (PEEP0: 65.0% ± 10.6%; PEEP5: 68.7% ± 8.7%; PEEPtitr: 68.2% ± 10.5%; PEEP15: 58.4% ± 12.8%; P = 0.096), but the centers of relative perfusion and ventilation in the ventilated lung shifted from ventral to dorsal and from cranial to caudal zones with increasing PEEP. Conclusions In this experimental model of thoracic surgery, higher PEEP during OLV did not shift the perfusion from the ventilated to the nonventilated lung, thus not increasing intrapulmonary shunt. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New
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