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Comparisons of two ventilation modes with lung recruitment maneuver during one-lung ventilation in patients undergoing thoracoscopic lobectomy

Objective: The purpose of this study was to investigate the effects of two different ventilation modes: Volume-Controlled Ventilation (VCV) with Lung Recruitment Maneuvers (LRM) vs. Pressure- Controlled Ventilation (PCV) with LRM during One-Lung Ventilation (OLV) in patients undergoing thoracoscopic lobectomy.

Methods: Position of Double-lumen endobronchial tube (DLT) was assessed by a fiberoptic bronchoscope. At 10 min before LRM (T1), Mean Blood Pressure (MBP), Heart Rate (HR), arterial blood gas, Peak inspiratory pressure (Ppeak), mean inspiratory pressure (Pmean), dynamic compliance (Cdyn) were measured in each ventilation mode. At 20 min After LRM (T2), MBP, HR, arterial blood gas, Ppeak, Pmean and Cdyn were measured in every mode.

Results: The rate of change of index for VCV and PCV was PaO2+161.3% vs. +53.7%, SaO2+1.73% vs. +0.5%, respectively. At the point of T1, by comparing PCV with VCV, PaO2 was higher, which was statistically significant (P<0.05). By comparing T2 with T1, both VCV-LRM and PCV-LRM groups had a significant decrease in Ppeak and Pmean (P<0.05) .While they significantly increased the value of Cdyn (P<0.05). The rate of change of index for VCV and PCV was Ppeak-34.7% vs. -25.9%, Pmean-27.4% vs. -18.8%, Cdyn+73.2% vs. +35.4%, respectively. AT T1, compared with VCV-LRM group, Ppeak, Pmean and Cdyn was lower, lower and higher (P<0.05) in PCV-LRM group, the difference was statistically significant.

Conclusions: The VCV with LRM mode and PCV with LRM mode not only improved oxygenation during OLV for patients undergoing thoracoscopic lobectomy, but also attenuated airway pressure and improved dynamic compliance. It should be emphasized that the former is more effective than the latter.

Author(s): Wenjun Liu, Duomao Lin, Sajid Ali, Jun Ma