Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain.
Br J Anaesth. 2012 Mar;108(3):517-24. doi: 10.1093/bja/aer415. Epub 2011 Dec 26.
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.
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 H(2)O 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.
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 (VD(alv)/VT(alv)) increased throughout the protocol in the control but decreased in the ARS group. Differences in VD(alv)/VT(alv) between groups were significant (P<0.001). Except for baseline, all 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)].
Recruitment of both lungs before instituting OLV not only decreased alveolar dead space but also improved arterial oxygenation and the efficiency of ventilation.
本研究旨在确定在开始单肺通气（OLV）之前的双肺通气（TLV）期间应用肺泡复张策略（ARS）是否可以提高通气效率。
将受试者随机分为两组：（i）对照组：TLV 和 OLV 时分别采用潮气量（VT）8 或 6 ml/kg 的通气方式，（ii）ARS 组：采用相同的通气方式，在 OLV 前后分别给予 10 次平台压为 40 和 20 cm H₂O 的 ARS。记录容积二氧化碳图和动脉血样，分别在 TLV 开始后 5 分钟（基础）和 20 分钟、OLV 期间 20 分钟和 40 分钟以及重新建立 TLV 后 10 分钟。
每组 20 例。在所有受试者中，气道死腔成分在研究期间保持不变。与基础值相比，对照组的肺泡死腔比（VD(alv)/VT(alv)）在整个方案中均增加，而 ARS 组则减少。组间 VD(alv)/VT(alv)差异有统计学意义（P<0.001）。除基础值外，ARS 组的所有 kPa（标准差）值均高于对照组（P<0.001），分别为 [70（7）和 55（9）；33（9）和 24（10）；33（8）和 22（10）；70（7）和 55（10）]。
在开始 OLV 之前复张双肺不仅可以减少肺泡死腔，还可以改善动脉氧合和通气效率。
