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CARDIOVASCULAR ANESTHESIA

Two-Lung and One-Lung Ventilation in Patients with Chronic Obstructive Pulmonary Disease: The Effects of Position and FIO₂

Gizella I. Bardoczky, MD, PhD, DABA^*, Laszlo L. Szegedi, MD^*, Alain A. d’Hollander, MD, PhD^*, Jean-Marie Moures, MD^*, Philippe de Francquen, MD, and Jean-Claude Yernault, MD, PhD, FFCP

Departments of *Anesthesiology, Thoracic Surgery, and Chest Medicine, Erasme University Hospital, Free University of Brussels, Brussels, Belgium

Address correspondence and reprint requests to Laszlo L. Szegedi, MD, Department of Anesthesiology, Erasme University Hospital, Free University of Brussels, 808, route de Lennik, 1070 Brussels, Belgium.

We compared the effects of position and fraction of inspired oxygen (FIO₂) on oxygenation during thoracic surgery in 24 consenting patients randomly assigned to receive an FIO₂ of 0.4 (eight patients, Group 0.4), 0.6 (eight patients, Group 0.6), or 1.0 (eight patients, Group 1.0) during the periods of two-lung (TLV) and one-lung ventilation (OLV) in the supine and lateral positions. TLV and OLV were maintained while the patients were first in the supine and then in the lateral position for 15 min each. Thereafter, respiratory mechanical data were obtained, and arterial blood gas samples were drawn. PaO₂ decreased during OLV compared with TLV in both the supine and lateral positions. In all three groups, PaO₂ was significantly higher during OLV in the lateral than in the supine position: 101 (72–201) vs 63 (57–144) mm Hg in Group 0.4; 268 (162–311) vs 155 (114–235) mm Hg in Group 0.6; and 486 (288–563) vs 301 (216–422) mm Hg in Group 1.0, respectively (P < 0.02, Wilcoxon’s signed rank test). We conclude that, compared with the supine position, gravity augments the redistribution of perfusion as a result of hypoxic pulmonary vasoconstriction, when patients are in the lateral position, which explains the higher PaO₂ during OLV.

Implications: This study compares oxygenation during thoracic surgery during periods of two-lung and one-lung ventilation with patients in the supine and lateral positions when using three different fraction of inspired oxygen values. Arterial oxygen tension was decreased in all three groups during one-lung ventilation in comparison with the two-lung ventilation values, but the decrease was significantly less in the lateral, compared with the supine position.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999