A preemptive alveolar recruitment strategy before one-lung ventilation improves arterial oxygenation in patients undergoing thoracic surgery: a prospective randomised study

Abstract

BACKGROUND AND OBJECTIVE: Arterial hypoxaemia remains a problem during one-lung ventilation (OLV). We determined whether a preemptive alveolar recruitment strategy (ARS) before OLV improves arterial oxygenation during OLV in patients undergoing thoracic surgery. METHODS: Forty-two patients were allocated randomly to receive either a tidal volume of 10 ml kg(-1) (group C) or ARS of 10 manual breaths with a peak inspiratory pressure of 40 cmH2O followed by positive end-expiratory pressure (PEEP) of 15 cmH2O until OLV commenced (group P). The dependent lung was ventilated with a tidal volume of 6 ml kg(-1) and PEEP of 5 cmH2O during OLV in both groups. Arterial blood gas data were recorded before ARS (baseline), after 15, 30, 45, 60 min of OLV, and at the end of OLV. RESULTS: Baseline paO2 in group P was similar to that in group C (29.9 +/- 3.9 vs. 30.0 +/- 3.5 kPa). However, paO2 was significantly higher in group P than in group C during OLV (38.9 +/- 15.0 vs. 28.8 +/- 14.4 kPa after 15 min of OLV, 39.6 +/- 13.3 vs. 31.2 +/- 13.9 kPa after 60 min of OLV and 45.5 +/- 12.1 vs. 34.3 +/- 12.0 kPa before an air leakage test, P < 0.05). The alveolar-arterial oxygen gradient was significantly lower in group P than in group C after 15 min of OLV and at the end of OLV (46.1 +/- 14.4 vs. 55.9 +/- 14.7, 39.7 +/- 12.4 vs. 50.7 +/- 12.3 kPa, P < 0.05). CONCLUSION: Preemptive ARS before OLV is effective in improving arterial oxygenation during the entire period of OLV.