title: A preemptive alveolar recruitment strategy before one-lung ventilation improves arterial oxygenation in patients undergoing thoracic surgery: a prospective randomised study.
abstract: OBJECTIVE
  Arterial hypoxaemia remains a problem during one-lung ventilation (OLV). We determined whether a preemptive alveolar recruitment strategy (ARS) before OLV improves arterial oxygenation during OLV in patients undergoing thoracic surgery.
  
  
  METHODS
  Forty-two patients were allocated randomly to receive either a tidal volume of 10 ml kg(-1) (group C) or ARS of 10 manual breaths with a peak inspiratory pressure of 40 cmH2O followed by positive end-expiratory pressure (PEEP) of 15 cmH2O until OLV commenced (group P). The dependent lung was ventilated with a tidal volume of 6 ml kg(-1) and PEEP of 5 cmH2O during OLV in both groups. Arterial blood gas data were recorded before ARS (baseline), after 15, 30, 45, 60 min of OLV, and at the end of OLV.
  
  
  RESULTS
  Baseline paO2 in group P was similar to that in group C (29.9 +/- 3.9 vs. 30.0 +/- 3.5 kPa). However, paO2 was significantly higher in group P than in group C during OLV (38.9 +/- 15.0 vs. 28.8 +/- 14.4 kPa after 15 min of OLV, 39.6 +/- 13.3 vs. 31.2 +/- 13.9 kPa after 60 min of OLV and 45.5 +/- 12.1 vs. 34.3 +/- 12.0 kPa before an air leakage test, P < 0.05). The alveolar-arterial oxygen gradient was significantly lower in group P than in group C after 15 min of OLV and at the end of OLV (46.1 +/- 14.4 vs. 55.9 +/- 14.7, 39.7 +/- 12.4 vs. 50.7 +/- 12.3 kPa, P < 0.05).
  
  
  CONCLUSIONS
  Preemptive ARS before OLV is effective in improving arterial oxygenation during the entire period of OLV.
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Sungnam, South Korea.
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Park
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Jeon
authors.forename: Jung-Won
authors.initials: JW
authors.lastname: Hwang
authors.forename: Sang-Hwan
authors.initials: SH
authors.lastname: Do
authors.forename: Ju-Hee
authors.initials: JH
authors.lastname: Kim
authors.forename: Hee-Pyoung
authors.initials: HP
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D001784:Blood Gas Analysis; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation / Q000009:adverse effects; D010100:Oxygen / Q000097:blood*; D011175:Positive-Pressure Respiration; D011446:Prospective Studies; D011650:Pulmonary Alveoli / Q000502:physiology*; D056910:Republic of Korea; D019616:Thoracic Surgical Procedures; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D010100:Oxygen