Association of high tidal volume with postpneumonectomy failure.

摘要

To the Editor:-I read with interest the article titled "Intraoperative Tidal Volume as a Risk Factor for Respiratory Failure after Pneumo-nectomy" by Fernandez-Perez et al. This is an important article because the traditional approach to one-lung ventilation has been to deliver 10-12 ml/kg tidal volume. As the authors pointed out, two previous studies reported that high intraoperative airway pressures during one-lung ventilation were associated with postoperative acute lung injury. The study by Fernandez-Perez et al. showed that larger tidal volumes were associated with a higher risk of postoperative respiratory failure. However, the largest tidal volume recorded on the chart was used in the analysis. This would most likely have been during two-lung ventilation, evert if the tidal volume had been reduced during one-lung ventilation. If the tidal volume is not adjusted when initiating one-lung ventilation, the airway pressure will increase due to reduced compliance. It is possible that the ventilator will not deliver the full tidal volume, and then the largest recorded tidal volume would be the two-lung tidal volume.