Ventilation-Perfusion Distribution and Shunt Fraction during One-Lung Ventilation: Effect of Different Inhaled Oxygen Levels

Jane-Yi Hsu ； Wei-Teing Chen ； Chung-Cheng Kao ； Shih Jun Lee ； Hung Chang

《The Chinese Journal of Physiology》 51卷1期 (2008/02) Pp. 48-53

並列摘要

Ventilation with higher fraction of inspired oxygen (FIO2) is one of the commonly-chosen strategies executed for treatment of hypoxemia during one lung ventilation (OLV) for thoracic surgery. In this study, we investigated the effect of FIO2 on pulmonary ventilation-perfusion(VA/Q) distribution during OLV. Six pigs, weighing 27 to 34 kg, were selected for this study. Following by a steady-state period, randomized administrations of FIO2 with 0.4, 0.6 and 1.0 were performed for 30 minutes at the right lateral decubitus position during OLV, while hemodynamic data and lung mechanics were simultaneously monitored. The (VA/Q) distributions of the lung(s) were assessed by the multiple inert gas elimination technique (MIGET). PaO2 at FIO2 of 100% was significantly reduced in OLV compared with two-lung ventilation (TLV) (522 ± 104 vs. 653 ± 21 mmHg; P ＜ 0.001) at right lateral decubitus position. MIGET algorithms demonstrated a wider .(VA/Q) distribution during OLV at FIO2 of 40%, as compared with distribution during TLV at FIO2 of 100%, but a bimodal perfusion distribution shifted to lower (VA/Q) component during OLV at FIO2 of 100%. There was an increase of pulmonary shunting in OLV, as compared with TLV at FIO2 of 100% (1.94 ±2.2% vs. 9.5 ±9.7%; P ＜ 0.01). In addition, OLV caused a significant increase in the dispersion of perfusion at FIO2 of 100% (0.62 ± 0.20 vs. 0.44 ±0.23; P ＜ 0.01), but ventilation showed no denoting changes (1.06 ± 0.20 vs. 0.98 ±0.35; P ＞ 0.01). During OLV with right lateral decubitus position, there were no significant changes in the pulmonary shunt, the dispersion of perfusion and ventilation at different FIO2. OLV resulted in an increase in pulmonary shunting and heterogeneity compared with TLV. Furthermore, the PaO2 decreased during OLV regardless of the postural changes. At different FIO2, there were no significant changes in the pulmonary shunt, the dispersion of perfusion and ventilation during OLV with right lateral decubitus posture.

並列關鍵字

one lung ventilation ； hypoxic pulmonary vasoconstriction HPV ； oxygenation ； pulmonary gas exchange ； multiple inert gas elimination technique

參考文獻

Abe, K.,Mashimo, T.,Yoshiya, I.(1998).Arterial oxygenation and shunt fraction during one-lung ventilation: a comparison of isoflurane and sevoflurane.Anesth. Analg..86,1266-1270.

Bardoczky, G. I.,Szegedi, L. L.,d'Hollander, A. A.,Moures, J. M.,de Francquen, P.,Yernault, J. C.(2000).Two-lung and one-lung ventilation in patients with chronic obstructive pulmonary disease: the effects of position and FIO2.Anesth. Analg..90,35-41.

Chang, H.,Lai-Fook, S. J.,Domino, K. B.,Schimmel, C.,Hildebrandt, J.,Robertson, H. T.,Glenny, R. W.,Hlastala, M. P.(2002).Spatial distribution of ventilation and perfusion in anesthetized dogs in lateral postures.J. Appl. Physiol..92,745-762.

Cohen, E.(1997).Physiology of the lateral position and one-lung ventilation.Chest. Surg. Clin. N. Am..7,753-771.

Cooper, J. D.,Patterson, G. A.,Sundaresan, R. S.,Trulock, E. P.,Yusen, R. D.,Pohl, M. S.,Lefrak, S. S.(1996).Results of 150 consecutive bilateral lung volume reduction procedures in patients with severe emphysema.J. Thorac. Cardiovasc. Surg..112,1319-1329.