Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Braz J Anesthesiol. 2021 Sep-Oct;71(5):565-571. doi: 10.1016/j.bjane.2021.04.001. Epub 2021 Apr 22.
With the intensive study of lung protective ventilation strategies, people begin to advocate the individualized application of positive end-expiratory pressure (PEEP). This study investigated the optimal PEEP in patients during one-lung ventilation (OLV) and its effects on pulmonary mechanics and oxygenation.
Fifty-eight patients who underwent elective thoracoscopic lobectomy were randomly divided into two groups. Both groups received an alveolar recruitment maneuver (ARM) after OLV. Patients in Group A received optimal PEEP followed by PEEP decremental titration, while Group B received standard 5 cmHO PEEP until the end of OLV. Relevant indexes of respiratory mechanics, pulmonary oxygenation and hemodynamics were recorded after entering the operating room (T), 10 minutes after intubation (T), pre-ARM (T), 20 minutes after the application of optimal PEEP (T), at the end of OLV (T) and at the end of surgery (T). Postoperative outcomes were also assessed.
The optimal PEEP obtained in Group A was 8.8 ± 2.4 cmHO, which positively correlated with BMI and forced vital capacity (FVC). Group A had a higher C than Group B at T, T, T (p < 0.05) and a smaller ΔP than Group B at T, T (p < 0.01). At T, PaO was significantly higher in Group A (p < 0.01). At T, stroke volume variation was higher in Group A (p < 0.01). Postoperative outcomes did not differ between the two groups.
Our findings suggest that the individualized PEEP can increase lung compliance, reduce driving pressure, and improve pulmonary oxygenation in patients undergoing thoracoscopic lobectomy, with little effect on hemodynamics.
随着肺保护性通气策略的深入研究，人们开始提倡个体化应用呼气末正压（PEEP）。本研究旨在探讨单肺通气（OLV）期间患者的最佳 PEEP 值及其对肺力学和氧合的影响。
选择择期行胸腔镜肺叶切除术的患者 58 例，随机分为两组。两组患者在 OLV 后均行肺泡复张手法（ARM）。A 组患者在接受最佳 PEEP 后，进行 PEEP 递减滴定，B 组患者则在 OLV 结束前接受标准的 5cmH2O PEEP。记录患者进入手术室（T）、插管后 10 分钟（T）、ARM 前（T）、应用最佳 PEEP 后 20 分钟（T）、OLV 结束时（T）和手术结束时（T）的呼吸力学、肺氧合和血流动力学相关指标。同时评估术后转归。
A 组获得的最佳 PEEP 为 8.8±2.4cmH2O，与 BMI 和用力肺活量（FVC）呈正相关。与 B 组相比，A 组在 T、T、T 时的 C 更高（p<0.05），在 T、T 时的ΔP 更小（p<0.01）。A 组在 T 时的 PaO2 显著高于 B 组（p<0.01）。A 组在 T 时的每搏量变异度更高（p<0.01）。两组患者的术后转归无差异。
本研究发现个体化 PEEP 可增加肺顺应性，降低驱动压，改善胸腔镜肺叶切除患者的肺氧合，对血流动力学影响较小。
