Differential Lung Ventilation vs. CPAP

Study Overview
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Brief Summary
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In this study we compared the efficacy of continuous positive airway pressure (CPAP) to differential lung ventilation, in terms of patient's oxygenation, during video assisted thoracoscopic lung resection.

Detailed Description
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Background: One Lung Ventilation (OLV) is the technique used during lung resection surgery in order to facilitate optimal surgical conditions. OLV may result in hypoxemia due to the shunt created. Several techniques are used to overcome the hypoxemia, one of which is continuous positive airway pressure (CPAP) to the non-dependent lung. Another technique is ventilating the non-dependent lung with a minimal volume, thus creating differential lung ventilation (DLV). In this study we compared the efficacy of CPAP to DLV during video assisted thoracoscopic lung resection. Patients and Method: This is a prospective study of 30 adult patients undergoing elective video assisted thoracoscopic lung lobectomy. Each patient was ventilated in four modes: two lung ventilation, OLV, OLV+CPAP and OLV+DLV. Fifteen patients were ventilated with CPAP first and DLV next, and the other 15 were ventilated with DLV first and then CPAP. Five minutes separated each mode, during which the non-dependent lung was open to room air. We measured the patient's arterial blood gas during each mode of ventilation. The surgeons, who were blinded to the ventilation technique, were asked to assess the surgical conditions at each stage.

Official Title
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Differential Lung Ventilation vs. CPAP During One Lung Ventilation for Video Assisted Lung Surgery

Conditions
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One Lung Ventilation, Continuous Positive Airway Pressure, Differential Lung Ventilation

Intervention / Treatment
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* Device: cpap


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients diagnised with lung cancer Scheduled to have thoracoscopic lung lobectomy - Exclusion Criteria: Pregnancy ASA>=4 Difficult intubation -

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: prospective randomized controlled crossover study
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: cpap first, differential ventilation later<br> | Device: cpap<br>* application of cpap to the non-dependent lung, during one lung ventilation<br>|
| Active Comparator: differential ventilation first, cpap late<br> | Device: cpap<br>* application of cpap to the non-dependent lung, during one lung ventilation<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| arterial blood oxygenation | PaO2 | intraoperative | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| interference with surgical field exposure | interference | intraoperative | 
| airway pressure in the dependent lung during one lung ventilation | airway pressure | intraoperative | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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one lung ventilation, continuous positive airway pressure, differential lung ventilation