Wittenstein Jakob, Scharffenberg Martin, Yang Xiuli, Bluth Thomas, Kiss Thomas, Schultz Marcus J, Rocco Patricia R M, Pelosi Paolo, Gama de Abreu Marcelo, Huhle Robert
Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus Dresden at Technische Universität Dresden, Dresden, Germany.
Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, Hefei, China.
Front Physiol. 2023 Aug 4;14:1204531. doi: 10.3389/fphys.2023.1204531. eCollection 2023.
. Global and regional transpulmonary pressure (P) during one-lung ventilation (OLV) is poorly characterized. We hypothesized that global and regional P and driving P (ΔP) increase during protective low tidal volume OLV compared to two-lung ventilation (TLV), and vary with body position. . In sixteen anesthetized juvenile pigs, intra-pleural pressure sensors were placed in ventral, dorsal, and caudal zones of the left hemithorax by video-assisted thoracoscopy. A right thoracotomy was performed and lipopolysaccharide administered intravenously to mimic the inflammatory response due to thoracic surgery. Animals were ventilated in a volume-controlled mode with a tidal volume (V) of 6 mL kg during TLV and of 5 mL kg during OLV and a positive end-expiratory pressure (PEEP) of 5 cmHO. Global and local transpulmonary pressures were calculated. Lung instability was defined as end-expiratory P<2.9 cmHO according to previous investigations. Variables were acquired during TLV (TLVsupine), left lung ventilation in supine (OLVsupine), semilateral (OLVsemilateral), lateral (OLVlateral) and prone (OLVprone) positions randomized according to Latin-square sequence. Effects of position were tested using repeated measures ANOVA. . End-expiratory P and ΔP were higher during OLVsupine than TLVsupine. During OLV, regional end-inspiratory P and ΔP did not differ significantly among body positions. Yet, end-expiratory P was lower in semilateral (ventral: 4.8 ± 2.9 cmHO; caudal: 3.1 ± 2.6 cmHO) and lateral (ventral: 1.9 ± 3.3 cmHO; caudal: 2.7 ± 1.7 cmHO) compared to supine (ventral: 4.8 ± 2.9 cmHO; caudal: 3.1 ± 2.6 cmHO) and prone position (ventral: 1.7 ± 2.5 cmHO; caudal: 3.3 ± 1.6 cmHO), mainly in ventral ( ≤ 0.001) and caudal ( = 0.007) regions. Lung instability was detected more often in semilateral (26 out of 48 measurements; = 0.012) and lateral (29 out of 48 measurements, < 0.001) as compared to supine position (15 out of 48 measurements), and more often in lateral as compared to prone position (19 out of 48 measurements, = 0.027). . Compared to TLV, OLV increased lung stress. Body position did not affect stress of the ventilated lung during OLV, but lung stability was lowest in semilateral and lateral decubitus position.
单肺通气（OLV）期间的全球和区域跨肺压（P）特征尚不明确。我们假设，与双肺通气（TLV）相比，在保护性低潮气量OLV期间，全球和区域P以及驱动压（ΔP）会增加，并且会随体位变化。在16只麻醉的幼年猪中，通过电视辅助胸腔镜在左半胸的腹侧、背侧和尾侧区域放置胸膜腔内压传感器。进行右胸切开术并静脉注射脂多糖，以模拟胸外科手术引起的炎症反应。动物以容量控制模式通气，TLV期间潮气量（V）为6 mL/kg，OLV期间为5 mL/kg，呼气末正压（PEEP）为5 cmH₂O。计算全球和局部跨肺压。根据先前的研究，肺不稳定性定义为呼气末P<2.9 cmH₂O。在TLV（TLV仰卧位）、仰卧位左肺通气（OLV仰卧位）、半侧卧位（OLV半侧卧位）、侧卧位（OLV侧卧位）和俯卧位（OLV俯卧位）期间，按照拉丁方序列随机获取变量。使用重复测量方差分析测试体位的影响。OLV仰卧位期间的呼气末P和ΔP高于TLV仰卧位。在OLV期间，区域吸气末P和ΔP在不同体位之间无显著差异。然而，与仰卧位（腹侧：4.8±2.9 cmH₂O；尾侧：3.1±2.6 cmH₂O）和俯卧位（腹侧：1.7±2.5 cmH₂O；尾侧：3.3±1.6 cmH₂O）相比，半侧卧位（腹侧：4.8±2.9 cmH₂O；尾侧：3.1±2.6 cmH₂O）和侧卧位（腹侧：1.9±3.3 cmH₂O；尾侧：2.7±1.7 cmH₂O）的呼气末P较低，主要在腹侧（≤0.001）和尾侧（=0.007）区域。与仰卧位（48次测量中有15次）相比，半侧卧位（48次测量中有26次；=0.012）和侧卧位（48次测量中有29次，<0.001）更常检测到肺不稳定性，与俯卧位（48次测量中有19次，=0.027）相比，侧卧位更常检测到肺不稳定性。与TLV相比，OLV增加了肺应力。体位在OLV期间不影响通气肺的应力，但半侧卧位和侧卧位时肺稳定性最低。
