Lung Diseases Clinical Trial
Official title:
Prospective Study of the Effects of Non-dependent Lung High Frequency Positive Pressure Ventilation on the Right Ventricular Function for Thoracotomy
The investigators hypothesized that the application of volume-controlled HFPPV to the
non-dependent lung during one-lung ventilation (OLV) for thoracotomy in patients with good
pulmonary functions and mild-to-moderate pulmonary dysfunction may provide preservation of
the right ventricular (RV) function, adequate oxygenation and optimum surgical conditions.
The investigators evaluated the effects of IL-HFPPV on RV ejection fraction (REF), RV
end-diastolic volume (RVEDVI), RV stroke work (RVSWI), pulmonary vascular resistance (PVRI),
and stroke volume (SVI) indices, oxygen delivery (DO2) and uptake (VO2), shunt fraction (Qs:
Qt), and surgical field conditions during OLV for thoracotomy in patients with good and
mild-to-moderate impaired pulmonary functions.
One-lung ventilation (OLV) provides an adequate operative field, but is opposed by the
induced hypoxic pulmonary vasoconstriction (HPV) in the non-ventilated lung. It may preserve
overall oxygen delivery, however with deleterious increase in shunt fraction and pulmonary
vascular resistance.1-2Right ventricular (RV) overload resulting from these increases in its
afterload influences postoperative morbidity and mortality. Intrinsic positive
end-expiratory pressure (PEEPi) occurs frequently during OLV for thoracic surgery in the
dependent lung of patients with pulmonary hyperinflation as opposed to patients with normal
pulmonary function.3 The different approaches for the correction of hypoxemia during OLV may
require some degree of recruitment of the non-dependent lung (IL), with different maneuvers
such as the application of continuous positive pressure ventilation (CPAP) or high frequency
jet ventilation (HFJV) to the non-dependent lung. These recruitment strategies, although
they may improve arterial saturation, may concurrently decrease cardiac output, therefore
having contradictory effects on overall oxygen delivery.4-6 Gas trapping may occur with
increased ventilatory frequency during HFJV. This may impair RVEF through the increases in
RV afterload.7 Therefore, the use of high frequency positive pressure ventilation (HFPPV)
using tidal volumes just greater than the dead space increases arterial oxygen tension
(PaO2) and the carbon dioxide excretion (VCO2) linearly with increasing peak airway
pressure.8 We hypothesized that the application of volume-controlled HFPPV to the
non-dependent lung during OLV for thoracotomy in patients with good pulmonary functions and
mild-to-moderate pulmonary dysfunction may provide preservation of the RV function, adequate
oxygenation and optimum surgical conditions.
We evaluated the effects of IL-HFPPV on RV ejection fraction (REF), RV end-diastolic volume
(RVEDVI), RV stroke work (RVSWI), pulmonary vascular resistance (PVRI), and stroke volume
(SVI) indices, oxygen delivery (DO2) and uptake (VO2), shunt fraction (Qs: Qt), and surgical
field conditions during OLV for thoracotomy in patients with good and mild-to-moderate
impaired pulmonary functions.
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment
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