This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (4) Citing Articles via Google Scholar Google Scholar Articles by Bardoczky, G. I. Articles by Yernault, J.-C. Search for Related Content PubMed PubMed Citation Articles by Bardoczky, G. I. Articles by Yernault, J.-C.

---

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.

This article has been cited by other articles:

				E. Mirzabeigi, C. Johnson, and A. Ternian One-Lung Anesthesia Update Seminars in Cardiothoracic and Vascular Anesthesia, September 1, 2005; 9(3): 213 - 226. [Abstract] [PDF]

				A. I. Levin and J. F. Coetzee Arterial Oxygenation During One-Lung Anesthesia Anesth. Analg., January 1, 2005; 100(1): 12 - 14. [Full Text] [PDF]

				S. Inoue, N. Nishimine, K. Kitaguchi, H. Furuya, and S. Taniguchi Double lumen tube location predicts tube malposition and hypoxaemia during one lung ventilation Br. J. Anaesth., February 1, 2004; 92(2): 195 - 201. [Abstract] [Full Text] [PDF]

				H. Kinoshita, Y. Kimoto, K. Nakahata, H. Iranami, M. Dojo, and Y. Hatano The Role of K+ Channels in Vasorelaxation Induced by Hypoxia and the Modulator Effects of Lidocaine in the Rat Carotid Artery Anesth. Analg., August 1, 2003; 97(2): 333 - 338. [Abstract] [Full Text] [PDF]

				S. Ishikawa, K. Nakazawa, and K. Makita Progressive changes in arterial oxygenation during one-lung anaesthesia are related to the response to compression of the non-dependent lung Br. J. Anaesth., January 1, 2003; 90(1): 21 - 26. [Abstract] [Full Text] [PDF]

				K. Schwarzkopf, T. Schreiber, R. Bauer, H. Schubert, N.-P. Preussler, E. Gaser, U. Klein, and W. Karzai The Effects of Increasing Concentrations of Isoflurane and Desflurane on Pulmonary Perfusion and Systemic Oxygenation During One-Lung Ventilation in Pigs Anesth. Analg., December 1, 2001; 93(6): 1434 - 1438. [Abstract] [Full Text] [PDF]

				J. Ribas, M. J. Jimenez, J. A. Barbera, J. Roca, C. Gomar, E. Canalis, and R. Rodriguez-Roisin Gas Exchange and Pulmonary Hemodynamics During Lung Resection in Patients at Increased Risk : Relationship With Preoperative Exercise Testing Chest, September 1, 2001; 120(3): 852 - 859. [Abstract] [Full Text] [PDF]