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CARDIOVASCULAR ANESTHESIA

Oxygenation During One-Lung Ventilation: The Effects of Inhaled Nitric Oxide and Increasing Levels of Inspired Fraction of Oxygen

Konrad Schwarzkopf, MD^*, Uwe Klein, MD^*, Torsten Schreiber, MD^*, Niels-Peter Preußler, MD^*, Frank Bloos, MD, PhD^*, Herry Helfritsch, MD, Franziska Sauer^*, and Waheedullah Karzai, MD^*

Departments of *Anesthesiology and Intensive Care Therapy and Surgery, University Hospital, 07740 Jena, Germany

Address correspondence and reprint requests to Waheedullah Karzai, MD, Department of Anesthesiology, University Hospital, Bachstrasse 18, 07740 Jena, Germany. Address e-mail to W.Karzai{at}med.uni-jena.de

We studied whether inhaled nitric oxide (NO) would improve arterial oxygen tension (PaO₂) and reduce the occurrence of oxygen saturation of hemoglobin (O₂Hb) <90% during one-lung ventilation (OLV). One-hundred-fifty-two patients were ventilated either with or without NO (20 ppm) with an inspired fraction of oxygen (FIO₂) of either 0.3, 0.5, or 1.0 during OLV. Anesthesia was induced and maintained with propofol, remifentanil, and rocuronium IV, and lung separation was achieved with a double-lumen tube. During OLV, we set positive end-expiratory pressure at 5 cm H₂O, peak pressure at 30 cm H₂O, and end-tidal CO₂ at 30 mm Hg. The nonventilated lung was opened to room air and collapsed. During OLV, three consecutive measurements were performed every 10 min. The operated lung was temporarily ventilated if pulse oximetric saturation (SpO₂) decreased to <91%. SpO₂ <91% occurred in 2 of the 152 patients. SpO₂ overestimated O₂Hb by 2.9% ± 0.1%. NO failed to improve oxygenation or alter occurrence of O₂Hb <90% during OLV across all time points and all levels of FIO₂. Increasing FIO₂ increased oxygenation and decreased occurrence of O₂Hb <90% (P < 0.001). At FIO₂ = 1, PaO₂ was higher (P < 0.01) and O₂Hb <90% rate tended to be lower (P = 0.1) during right versus left lung ventilation. PaO₂ was higher in patients undergoing pneumonectomy and lobectomy than in those undergoing metastasectomy or video-assisted operations (P < 0.05).

Implications: Inhaled nitric oxide failed to improve oxygenation during one-lung ventilation. Oxygenation during one-lung ventilation was improved with increasing levels of FIO₂ during ventilation of the right versus the left lung and with increasing pathology of the nonventilated lung.

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