Influence of tidal volume on ventilation distribution and oxygenation during one-lung?ventilation

摘要

Incorrect ventilator settings have the potential to induce lung injury. For this reason, the individualized setting of tidal volume (Vr) or variable V7 could be more physiology- oriented and thus improve patient outcomes [1]. In thoracic surgery, where one-lung ventilation (OLV) is performed, the setting of Vr is more challenging than during the ventilation of both lungs. Vz, which is regarded as low during a normal two-lung ventilation scenario, could be too high during OLV, potentially inducing baro- traumas. However, simply reducing V; to half during OLV may be insufficiently low to secure adequate gas exchange and result in hypoxemia [2]. We have conducted a study to explore the feasibility of titrating V7 during OLV at the bedside, based on ventilation distribution and oxygena- tion. The rationale was to monitor the regional ventilation distribution to avoid volutrauma with acceptable levels of blood gasses.