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Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation

Wirkung eines niedrigen Atemzugvolumens bei PEEP auf die Atemfunktion bei Säuglingen mit Ein-Lungen-Ventilation

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Abstract

Background

An increasing number of studies have shown that low tidal volume (TV) with positive end-expiratory pressure (PEEP) offers lung protection during one-lung ventilation (OLV). Considering the unique physiological characteristics of infants, we aimed to determine the feasibility and effect of low TV with PEEP in infants undergoing OLV during thoracoscopy.

Patients and methods

We randomized 60 infants to a conventional group (group I: TV, 8–10 ml/kg; RR, 23–45 bpm; PEEP, 0 cmH2O) or a low TV with PEEP group (group II: TV, 5–7 ml/kg; RR, 23–45 bpm; PEEP, 4–6 cmH2O). Arterial blood gas analyses were performed at four time points: 5 min of two-lung ventilation (TLV, T0), and 20 min, 40 min, and 60 min of OLV (T1, T2, T3); hemodynamic parameters (heart rate, mean blood pressure), temperature, as well as gas exchange (SpO2 and PETCO2) and ventilation parameters (FiO2, PEEP, Pmax) were recorded simultaneously. Lung compliance and shunt were also calculated.

Result

No significant difference was found between both groups at T0. Compared with T0, PETCO2, Pmax, PaCO2, lactic acid, and intrapulmonary shunt volume (Qs/Qt) were increased while PaO2 and respiratory system compliance (Cdyx) were decreased noticeably in both groups at T1, T2, and T3. At T1, T2, and T3, Pmax and Qs/Qt were much lower while PETCO2, PaCO2, and Cdyx were higher in group II than in group I. There was no significant difference in lactic acid and PaO2 measurements between the two groups at T1, T2, and T3.

Conclusion

Low TV with PEEP could be an effective intraoperative ventilation strategy for infants undergoing OLV during video-assisted thoracoscopic surgery and may reduce the risk of lung injury. However, this strategy, as well as the influence of intraoperative hypercapnia on infants, needs further investigation.

Zusammenfassung

Hintergrund

In immer mehr Studien zeigt sich, dass ein niedriges Atemzugvolumen (AZV) bei positivem endexpiratorischem Druck („positive end-expiratory pressure“, PEEP) die Lunge unter Ein-Lungen-Ventilation („one-lung ventilation“, OLV) schont. Unter Berücksichtigung der physiologischen Besonderheiten von Säuglingen war es Ziel der Autoren, die Praktikabilität und Wirkung eines niedrigen AZV bei PEEP für Säuglinge während einer Thorakoskopie unter OLV zu untersuchen.

Patienten und Methoden

Es wurden 60 Säuglinge auf die konventionelle Gruppe (Gruppe I; AZV: 8–10 ml/kg; Atemfrequenz, AF: 23–45/min; PEEP: 0 cmH2O) oder auf die Gruppe mit niedrigem AZV bei PEEP randomisiert (Gruppe II; AZV: 5–7 ml/kg; AF: 23–45/min; PEEP: 4–6 cmH2O). Arterielle Blutgasanalysen erfolgten zu 4 Zeitpunkten: 5 min 2‑Lungen-Ventilation („two-lung ventilation“, TLV, T0) sowie 20 min, 40 min und 60 min OLV (T1, T2, T3); hämodynamische Parameter (Herzfrequenz, mittlerer Blutdruck), Temperatur sowie Gasaustausch- (pulsoxymetrisch gemessene Sauerstoffsättigung, SpO2, und endtidaler Kohlendioxidpartialdruck, PETCO2) und Beatmungsparameter (inspiratorische Sauerstoffkonzentration, FiO2; PEEP; maximaler Atemwegsdruck, Pmax) wurden gleichzeitig erfasst. Lungencompliance und -shunt wurden ebenfalls ermittelt.

Ergebnisse

Es wurde kein signifikanter Unterschied zwischen beiden Gruppen an T0 festgestellt. Dagegen waren in beiden Gruppen PETCO2, Pmax, PaCO2 (arterieller CO2-Partialdruck), Milchsäure und intrapulmonales Shuntvolumen (Qs/Qt) erhöht, während PaO2 (arterieller O2-Partialdruck) und die Compliance des respiratorischen Systems (Cdyx) an T1, T2 und T3 deutlich erniedrigt waren. An T1, T2 und T3 waren Pmax und Qs/Qt viel niedriger, während PETCO2, PaCO2 und Cdyx in Gruppe II höher als Gruppe I waren. Zwischen den beiden Gruppen bestand kein signifikanter Unterschied bei Milchsäure und PaO2 an T1, T2 und T3.

Schlussfolgerung

Ein niedriges AZV bei PEEP könnte eine wirksame intraoperative Beatmungsform für Säuglinge unter OLV während videoassistierter thorakoskopischer Operationen (VATS) darstellen und das Risiko einer Lungenschädigung vermindern. Jedoch sind weitere Studien dieses Vorgehens sowie des Einflusses der intraoperativen Hyperkapnie auf Säuglinge erforderlich.

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Authors and Affiliations

  1. Department of Anesthesiology, Gangdong Women and Children Hospital, 510010, Gangzhou, China

    Jing Liu, Yongle Li, Hui Luo, Weijian Huang, Lingli Peng, Qin Fang & Zurong Hu

  2. FoShan City Nanhai District People’s Hospital, 528200, Foshan, China

    Xinfang Liao

  3. No. 521, Xingnandadao, Panyu District, Guangzhou, Guangdong, China

    Zurong Hu

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  1. Jing Liu
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  3. Yongle Li
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Correspondence to Zurong Hu.

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J. Liu, X. Liao, Y. Li, H. Luo, W. Huang, L. Peng, Q. Fang, and Z. Hu declare that they have no competing interests.

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Jing Liu and Xinfang Liao contributed equally to this study and share first authorship.

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Liu, J., Liao, X., Li, Y. et al. Effect of low tidal volume with PEEP on respiratory function in infants undergoing one-lung ventilation . Anaesthesist 66, 667–671 (2017). https://doi.org/10.1007/s00101-017-0330-4

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  • DOI: https://doi.org/10.1007/s00101-017-0330-4

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