Application value of open lung strategy in titration of positive end-expiratory pressure in radical esophagectomy

doi:10.3877/cma.j.issn.2095-655X.2021.02.013

Abstract

Abstract:

Objective

To explore the application value of open lung strategy (OLS) in titration of positive end-expiratory pressure (PEEP) in patients undergoing radical esophagectomy.

Methods

From February 2019 to February 2020, 60 patients who planned to undergo radical resection of esophageal carcinoma under optional one-lung ventilation (OLV) in the Department of Thoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, were randomly divided into experimental group (n=30) and control group (n=30) according to random number table method. In OLV, 5 cmH₂O (1 cmH₂O=0.098 kPa) was taken as the initial PEEP value in both groups. OLS was performed in the experimental group after hemodynamic stability, the highest compliance PEEP was detected and the catheter was applied until the end of the operation. In the control group, endotracheal catheter was extracted at PEEP=5 cmH₂O until the end of operation. Airway plateau pressure (Pplat), airway peak pressure (Ppeak), and lung dynamic compliance (Cdyn) were recorded in the two groups after intubation (T₁), OLV immediate (T₂), OLS 30 min after OLS application (T₃), OLS 60 min after OLS application (T₄). Arterial blood was extracted at the above time points for blood gas analysis, arterial oxygen partial pressure (PaO₂) and arterial carbon dioxide partial pressure (PaCO₂) were recorded, and the oxygenation index (OI) was calculated. Repeated measurement analysis of variance was used to compare oxygenation and respiratory dynamics indexes between the two groups at different time points above.

Results

From T₁ to T₄, there were no significant differences in PaCO₂ between the experimental group [(38.70±2.93)mmHg, (38.89±3.54)mmHg, (39.19±3.43)mmHg, (39.54±3.17)mmHg] and the control group [(39.72±3.19)mmHg, (40.35±3.71)mmHg, (39.66±3.47)mmHg, (39.54±3.42)mmHg] (F=1.67, 2.15, 0.27, 0.04, all P>0.05). Compare the OI, Pplat, Ppeak and Cdyn of two groups from T₁ to T₄, there were significant differences (F=13.29, 15.02, 7.05, 33.62, all P<0.05). At T₃ and T₄, OI [(259.30±30.68)mmHg, (267.39±33.81)mmHg], Pplat[ (17.98±2.56)cmH₂O, (17.09±2.87)cmH₂O], Ppeak[(27.74±4.68)cmH₂O, (27.27±3.03)cmH₂O], Cdyn[(33.44±2.74)ml/cmH₂O, (35.35±3.42)ml/cmH₂O] in experimental group were significantly increased when compared with those of the control group[(238.00±31.02)mmHg, (234.83±34.90)mmHg, (15.63±3.24)cmH₂O, (14.92±2.64)cmH₂O, (25.27±4.35)cmH₂O, (25.60±2.72)cmH₂O, (27.70±3.54)ml/cmH₂O, (28.20±3.69)ml/cmH₂O] (F=7.15, 13.47, 9.75, 9.20, 4.48, 5.03, 49.23, 60.51, all P<0.05). At T₃ and T₄, OI, Pplat, Ppeak, Cdyn in experimental group were significantly increased when compared with those at the T₂ [(238.00±31.02)mmHg, (13.89±3.16)cmH₂O, (22.37±2.11)cmH₂O, (28.16±3.15)ml/cmH₂O] (t=-2.43, -3.35, -5.74, -4.48, -6.82, -6.28, -5.55, -7.56, all P<0.05).

Conclusions

The oxygenation index of patients undergoing radical resection of esophageal cancer under general anesthesia is decreased. The protective ventilation strategy of using OLS to titrate individualized PEEP could significantly improve oxygenation and increase lung compliance, which is conducive to the protective effect of lung ventilation.

Key words: One-lung ventilation, Open lung strategy, Positive-pressure respiration, Oxygenation, Lung compliance

Zhengjie Song, Feng Yuan, Peng Cao, Jinglin Cheng, Zhisong Li. Application value of open lung strategy in titration of positive end-expiratory pressure in radical esophagectomy[J]. Chinese Journal of Diagnostics(Electronic Edition), 2021, 09(02): 121-126.

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References 22

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项目	试验组(n＝30)	对照组(n＝30)	统计量	P值
男/女(例)	21/9	23/7	χ²＝0.34	0.559
年龄(岁，±s)	59.47±6.69	59.67±5.40	t＝-0.13	0.899
ASA分级[Ⅱ/Ⅲ，例]	14/16	18/12	χ²＝1.07	0.301
BMI(kg/m²，±s)	21.78±2.28	22.39±1.94	t＝-1.12	0.267
OLV时间(min，±s)	138.67±11.48	139.73±10.81	t＝-0.37	0.712
手术时间(min，±s)	200.70±23.34	199.27±21.41	t＝ 0.25	0.805

项目	试验组(n＝30)	对照组(n＝30)	统计量	P值
男/女(例)	21/9	23/7	χ²＝0.34	0.559
年龄(岁，±s)	59.47±6.69	59.67±5.40	t＝-0.13	0.899
ASA分级[Ⅱ/Ⅲ，例]	14/16	18/12	χ²＝1.07	0.301
BMI(kg/m²，±s)	21.78±2.28	22.39±1.94	t＝-1.12	0.267
OLV时间(min，±s)	138.67±11.48	139.73±10.81	t＝-0.37	0.712
手术时间(min，±s)	200.70±23.34	199.27±21.41	t＝ 0.25	0.805

组别	例数	PaCO₂				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	38.70±2.93	38.89±3.54	39.19±3.43	39.71±3.17	1.88	0.176
对照组	30	39.72±3.19	40.35±3.71	39.66±3.47	39.54±3.42	1.88	0.176
组别	例数	OI				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	433.00±39.61	238.00±31.02	259.30±30.68^ab	267.39±33.81^ab	13.29	0.001
对照组	30	423.43±36.09	230.57±33.21	238.00±31.02	234.83±34.90	13.29	0.001

组别	例数	PaCO₂				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	38.70±2.93	38.89±3.54	39.19±3.43	39.71±3.17	1.88	0.176
对照组	30	39.72±3.19	40.35±3.71	39.66±3.47	39.54±3.42	1.88	0.176
组别	例数	OI				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	433.00±39.61	238.00±31.02	259.30±30.68^ab	267.39±33.81^ab	13.29	0.001
对照组	30	423.43±36.09	230.57±33.21	238.00±31.02	234.83±34.90	13.29	0.001

组别	例数	Pplat(cmH₂O)				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	10.38±2.36	13.89±3.16	17.98±2.56^cd	17.09±2.87^cd	15.02	0.000
对照组	30	10.66±1.62	12.87±3.03	15.63±3.24^d	14.92±2.64^d	15.02	0.000
组别	例数	Ppeak(cmH₂O)				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	21.81±3.11	22.37±2.11	27.74±4.68^cd	27.27±3.03^cd	7.05	0.010
对照组	30	21.46±2.32	21.75±2.36	25.27±4.35^d	25.60±2.72^d	7.05	0.010
组别	例数	Cdyn(ml/cmH₂O)				F值	P值
组别	例数	T₁	T₂	T₃	T₄	F值	P值
试验组	30	46.43±5.02	28.16±3.15	33.44±2.74^cd	35.35±3.42^cde	33.62	0.000
对照组	30	47.29±3.67	27.44±3.41	27.70±3.54	28.20±3.69	33.62	0.000

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