Effect of Optimal Positive End-Expiratory Pressure on Oxygenation and Intrapulmonary Shunt During One-lung Ventilation
Condition: Lung Cancer
Study type: Interventional

Summary: 
      To observe the effect of compliance guided an optimal Positive End-Expiratory
      Pressure（PEEP）on arterial oxygenation and intrapulmonary shunt during one-lung
      ventilation(OLV)，and discuss the lung protective effect of optimal PEEP during one-lung
      ventilation.
    

Detailed description: 
      Sixty patients undergoing thoracic surgery were randomly allocated to the study or control
      group.Patients were monitored for electrocardiogram, pulse oximetry, and non-invasive blood
      pressure,20 gauge cannula needle for radial artery catheterization under local anesthesia,
      monitoring ABP.,the right subclavian vein was selected for catheterization under local
      anesthesia,monitoring CVP.Anesthesia was induced with sufentanil 0.4 μg/kg, propofol 2 mg/kg,
      and cisatracurium 0.3 mg/kg.The trachea was intubated with a double-lumen tube (DLT)，37F for
      male and 35F for female patients.Tube position was confirmed by bronchoscopy in the supine
      and lateral positions.Anesthesia was maintained with sevoﬂurane 1.0-1.5 vol%，propofol 2-4
      mg/(kg·h) and remifentanil 0.1-0.2 μg/(kg·min) and intermittent cisatracurium 0.06-0.1
      mg/kg.The lungs were initially ventilated using a volume-controlled ventilation mode,two-lung
      ventilation(TLV):tidal volume (VT) 8 ml/kg,respiratory rate 12-14 bpm, inspiratory:expiratory
      (I:E) ratio 1:2, in 60% oxygen without PEEP. During OLV, VT was reduced to 6 ml/kg,OLV was
      initiated at the moment of skin incision.Both groups received an alveolar recruitment
      maneuver(increase inspiratory pressure to 30cmH2O for 10s) at the 10min after one-lung
      ventilation. After the alveolar recruitment maneuver,the study group titrate PEEP from
      4cmH2O,increased in 2cmH2O steps and hold at each step for 1min,and the static pulmonary
      compliance(Cst) would be record.Optimal PEEP was determined until the maximal static
      pulmonary compliance was obtained.In the control group at PEEP level of 5 cmH2O was
      established and maintained during the study period.Blood gas analyses, respiratory variables,
      and hemodynamic variables were recorded at 6 different time points:10 min after TLV(T0),
      10min after OLV(T1), 30min after PEEP(T2), 60min after PEEP(T3), 10min after the end OLV(T4)
      and 20min after extubation(T5).
    

Intervention name(s): compliance guided an optimal Positive End-Expiratory Pressure; PEEP level of 5 cmH2O
Intervention type(s): Device; Device
Intervention description(s): The study groups received an alveolar recruitment maneuver(increase inspiratory pressure to 30cmH2O for 10s) at the 10min after one-lung ventilation. After the alveolar recruitment maneuver,the study group titrate PEEP from 4cmH2O,increased in 2cmH2O steps and hold at each step for 1min,and the static pulmonary compliance(Cst) would be record.Optimal PEEP was determined until the maximal static pulmonary compliance was obtained.; In the control group at PEEP level of 5 cmH2O was established and maintained during the study period
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Care Provider)
Primary purpose: Supportive Care