侧卧位时两肺之间呼气末二氧化碳梯度在预测择期胸外科手术单肺通气期间氧合下降中的效用——一项前瞻性观察研究。

The utility of gradient of end-tidal carbon dioxide between two lungs in lateral decubitus position in predicting a drop in oxygenation during one-lung ventilation in elective thoracic surgery- A prospective observational study.

作者信息

Parab Swapnil Yeshwant, Chatterjee Aparna, Saxena Rishi S

机构信息

Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.

Department of Critical Care Medicine, Ramakrishna Care Hospital Raipur, Chhattisgarh, India.

出版信息

Indian J Anaesth. 2021 Oct;65(10):744-749. doi: 10.4103/ija.ija_591_21. Epub 2021 Oct 29.

DOI:10.4103/ija.ija_591_21

PMID:34898701

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8607859/

Abstract

BACKGROUND AND AIMS

Baseline difference in the perfusion of two lungs is the cause of intra-operative shunt during one-lung ventilation (OLV). This study aimed to test the hypothesis that the gradient of end-tidal carbon dioxide (EtCO) between two lungs in lateral position (D-EtCO) would predict the quantity of shunt and hence the drop in the oxygenation during OLV.

METHODS

An observational study was conducted to include consecutive 70 patients undergoing thoracic surgery using a double-lumen tube in a lateral position. D-EtCO was calculated by subtracting EtCO from the non-dependent lung from that of the dependent lung when ventilation parameters are the same for each lung. Oxygenation was assessed by measuring PaO/FiO ratios (P/F ratio) at 10, 20 and 40 min after OLV. Correlations between D-EtCO and P/F ratios were calculated. Receiver operating curves were analysed to test the ability of D-EtCO to identify patients with a P/F ratio of <100 during OLV.

RESULTS

A moderate correlation was found between D-EtCO and P/F ratios at 10 and 20 min of OLV. Among lung resection cases (n = 61), correlation was moderate at 10 (r = 0.64), and 20 min (r = 0.65) ( < 0.001) and became weak at 40 min (r = 0.489, < 0.001). Areas under curve for D-EtCO to predict the drop in P/F ratio <100 at 10, 20 and 40 min after OLV were 0.90 (cut-off: 2.5), 0.78 (cut-off: 3.5) and 0.78 (cut-off: 4.5), respectively.

CONCLUSION

D-EtCO could predict the drop in oxygenation in the early part of OLV in lung resection surgeries.

摘要

背景与目的

两肺灌注的基线差异是单肺通气（OLV）期间术中分流的原因。本研究旨在验证以下假设：侧卧位时两肺之间的呼气末二氧化碳（EtCO）梯度（D-EtCO）可预测分流的量，进而预测OLV期间氧合的下降。

方法

进行一项观察性研究，纳入70例连续接受胸外科手术且采用双腔管行侧卧位通气的患者。当两肺通气参数相同时，用依赖肺的EtCO减去非依赖肺的EtCO来计算D-EtCO。通过测量OLV后10、20和40分钟时的动脉血氧分压/吸入氧分数值（P/F比值）来评估氧合情况。计算D-EtCO与P/F比值之间的相关性。分析受试者工作曲线以检验D-EtCO识别OLV期间P/F比值<100的患者的能力。

结果

在OLV 10分钟和20分钟时，发现D-EtCO与P/F比值之间存在中度相关性。在肺切除病例（n = 61）中，10分钟时相关性为中度（r = 0.64），20分钟时为中度（r = 0.65）（P<0.001），40分钟时变弱（r = 0.489，P<0.001）。OLV后10、20和40分钟时，D-EtCO预测P/F比值下降<100的曲线下面积分别为0.90（临界值：2.5）、0.78（临界值：3.5）和0.78（临界值：4.5）。