Utjecaj pozitivnoga tlaka na kraju ekspirija na oksigenaciju i hemodinamske promjene tijekom operacije na plućima u bolesnika s redukcijom plućne funkcije Influence of ePEEP on oxygenation and hemodynamic changes during lung operation in patients with reduction of lung function

摘要

Use of ePEEP during OLV in patients with COPD is controversial. We intend to explore what is the impact of the application of the ePEEP on OLV in patients with COPD in relation to their BODE index. 137 patients with lung cancer and COPD in history, ASA physical status II-III scheduled for lobectomy were divided in six groups given the BODE index. At the beginning of OLV, in all patients ePEEP was gradually increased every 20 min for 2 cmH2O (0-8 cmH2O). Respiratory and hemodynamic parameters were carefully monitored. Arterial gas values were analised every 20 minutes. In our patients BODE index was 0-5. Most patients had BODE index 2, only three patients had the largest measured BODE index 5. Increased inspiratory pressure in all measurements occurred due to gradually increasing of ePEEP and statistically significant influence on values of mean arterial pressure didn’t occur. Optimal ePEEP in groups BODE 0-3 with which we have achieved the best oxygenation and ventilation and stability of the circulation was 8 cmH2O. Optimal ePEEP in group BODE 4 were 6 and 8 cmH2O and optimal ePEEP in group BODE 5 was 2 cmH2O. Increasing ePEEP best values of PaCO2, PaO2 and SaO2 were observed in the group with the lowest values of FEV1 and ePEEP 8 cmH2O. Statistically significant correlation was achieved in lowering PaCO2. Use of ePEEP on OLV in patients with COPD undergoing thoracic surgery, whose BODE index is not greater than 5 is safe and provides optimal ventilation.ud ud