The effect of positive end-expiratory pressure and continuous positive airway pressure on the oxygenation and shunt fraction during one-lung ventilation with propofol anesthesia.
OBJECTIVE
To evaluate the effect of positive end-expiratory pressure (PEEP) and continuous positive airway pressure (CPAP) on the oxygenation and shunt fraction during one-lung ventilation (OLV).


METHODS
Prospective clinical study.


METHODS
Inpatient thoracic surgery and anesthesia clinic at an University hospital.


METHODS
15 patients with esophageal cancer who were scheduled for radical surgery.


METHODS
Arterial oxygenation, shunt fraction, and hemodynamics were evaluated at 20 min after the start of operation, at 20 minutes after the initiation of OLV under zero end-expiratory pressure (ZEEP), 20 minutes after the application of 4 cm PEEP to the dependent lung, at 20 minutes after OLV under ZEEP, 20 minutes after the application of 4 cm CPAP to the nondependent lung, and again under ZEEP, and after the combined application of PEEP and CPAP to the dependent and nondependent lungs.


RESULTS
There were no significant changes in mean pulmonary artery pressure, mean arterial blood pressure, heart rate, mixed venous partial pressure of oxygen, or arterial and mixed venous saturation of oxygen (SVO(2)) during this study. Arterial partial pressure of oxygen (pO(2)) increased and shunt fraction values decreased significantly after the application of PEEP (pO(2); 197.8 +/- 32.9 mmHg, Qs/Qt; 22.9 +/- 5.6%), CPAP (pO(2); 212.6 +/- 15.9 mmHg, Qs/Qt; 22.8 +/- 5.9%), and combination of PEEP and CPAP (pO(2); 222.0 +/- 42.8 mmHg, Qs/Qt; 24.1 +/- 6.4%) compared with ZEEP (pO(2); 128.1 +/- 37.5 mmHg, Qs/Qt; 33.2 +/- 6.8% ). But there were no significant differences regarding oxygenation and shunt fraction during PEEP, CPAP, or the combination of PEEP and CPAP.


CONCLUSIONS
The application of PEEP to the dependent lung, CPAP to the nondependent lung, and the combination of PEEP and CPAP, are useful for improving oxygenation and decreasing Qs/Qt.
Fujiwara
M
M
Department of Anesthesiology, Osaka University Medical School, Osaka, Japan.
Abe
K
K
Mashimo
T
T
D000328:Adult; D000368:Aged; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D011175:Positive-Pressure Respiration; D015742:Propofol / Q000494:pharmacology*; D011446:Prospective Studies; D012121:Respiration, Artificial
D010100:Oxygen; D015742:Propofol