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Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial - 7/3/2012

Br J Anaesth 2012; 108: 517-24


These authors carried out a study 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 ml/kg or 6 ml/kg 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 cm H(2)O and 20 cm H(2)O PEEP applied immediately before and after OLV. Volumetric capnography and arterial blood samples were recorded 5 minutes (baseline) and 20 minutes into TLV, at 20 and 40 minutes during OLV, and finally 10 minutes 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 (VDalv/VTalv) increased throughout the protocol in the control but decreased in the ARS group. Differences in VDalv/VTalv between groups were significant (p<0.001). Except for baseline, all values in kPa (standard deviation) 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]).



The authors conclude that recruitment of both lungs before instituting OLV not only decreased alveolar dead space, but also improved arterial oxygenation and the efficiency of ventilation.

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