title: Intermittent reinflation is safe to maintain oxygenation without alteration of extravascular lung water during one-lung ventilation.
abstract: OBJECTIVE
  To investigate whether a maneuver for repeated cycles of collapse and reexpansion of the operative lung, termed "intermittent reinflation" (IR), to counter hypoxemia during one-lung ventilation (OLV), results in a time-dependent alteration of extravascular lung water.
  
  
  METHODS
  Prospective, randomized clinical study.
  
  
  METHODS
  Operating room and postsurgical intensive care unit of a university hospital.
  
  
  METHODS
  36 ASA physical status 1 and 2 patients undergoing elective, video-assisted thoracic surgery for lung tumors.
  
  
  METHODS
  Patients were randomly assigned to two groups. Group C consisted of 18 patients whose nondependent lung was kept collapsed during OLV, while Group IR included 18 patients with IR that consisted of 4 separate, 10-second manual inflations and 5-second openings within one minute at intervals of 20 minutes during OLV.
  
  
  METHODS
  Perioperative parameters included transcutaneous oxygen saturation (SpO2), hemodynamic data, extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) as determined by the single-indicator transpulmonary thermodilution technique, and partial pressure of arterial oxygen/inspired oxygen fraction (PaO2/FIO2) ratio.
  
  
  RESULTS
  Group IR had significantly higher SpO2 at 20 minutes after commencement of OLV (98.9% vs 96.3%, P = 0.029) and average SpO2 throughout OLV (98.7% vs 97.0%, P = 0.020). Hemodynamic data, EVLWI, PVPI, and PaO2/FIO2 ratio did not differ between the groups, and there were no differences between groups in postoperative morbidity or hospital stay.
  
  
  CONCLUSIONS
  Intermittent reinflation had a beneficial effect on oxygenation during OLV, without any significant effects on EVLW or postoperative outcomes.
authors.affiliation: Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551, Japan. Electronic address: yasuuji@hiroshima-u.ac.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yasuuji
authors.affiliation: Department of Anesthesiology and Critical Care, Hiroshima University Hospital, Hiroshima 734-8551, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Kusunoki
authors.affiliation: Department of Anesthesiology and Critical Care, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hamada
authors.affiliation: Department of Anesthesiology and Critical Care, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Kawamoto
mesh_terms: D000368:Aged; D015633:Extravascular Lung Water / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006785:Hospitals, University; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D061810:One-Lung Ventilation / Q000379:methods*; D010100:Oxygen / Q000378:metabolism*; D011446:Prospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*
chemical_list: D010100:Oxygen
keywords: Extravascular lung water; Intermittent reinflation; Lung injury; One-lung ventilation; Oxygenation, Maintenance of