title: "Open lung ventilation optimizes pulmonary function during lung surgery".
abstract: BACKGROUND
  We evaluated an "open lung" ventilation (OV) strategy using low tidal volumes, low respiratory rate, low FiO2, and high continuous positive airway pressure in patients undergoing major lung resections.
  
  
  METHODS
  In this phase I pilot study, twelve consecutive patients were anesthetized using conventional ventilator settings (CV) and then OV strategy during which oxygenation and lung compliance were noted. Subsequently, a lung resection was performed. Data were collected during both modes of ventilation in each patient, with each patient acting as his own control. The postoperative course was monitored for complications.
  
  
  RESULTS
  Twelve patients underwent open thoracotomies for seven lobectomies and five segmentectomies. The OV strategy provided consistent one-lung anesthesia and improved static compliance (40 ± 7 versus 25 ± 4 mL/cm H2O, P = 0.002) with airway pressures similar to CV. Postresection oxygenation (SpO2/FiO2) was better during OV (433 ± 11 versus 386 ± 15, P = 0.008). All postoperative chest x-rays were free of atelectasis or infiltrates. No patient required supplemental oxygen at any time postoperatively or on discharge. The mean hospital stay was 4 ± 1 d. There were no complications or mortality.
  
  
  CONCLUSIONS
  The OV strategy, previously shown to have benefits during mechanical ventilation of patients with respiratory failure, proved safe and effective in lung resection patients. Because postoperative pulmonary complications may be directly attributable to the anesthetic management, adopting an OV strategy that optimizes lung mechanics and gas exchange may help reduce postoperative problems and improve overall surgical results. A randomized trial is planned to ascertain whether this technique will reduce postoperative pulmonary complications.
authors.affiliation: Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: John B
authors.initials: JB
authors.lastname: Downs
authors.affiliation: Department of Thoracic Oncology (Surgery), Moffitt Cancer Center, Tampa, Florida. Electronic address: lary.robinson@moffitt.org.
authors.forename: Lary A
authors.initials: LA
authors.lastname: Robinson
authors.affiliation: Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steighner
authors.affiliation: Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: David
authors.initials: D
authors.lastname: Thrush
authors.affiliation: College of Arts and Sciences, University of South Florida Sarasota-Manatee, Florida; Department of Biostatistics, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Reich
authors.affiliation: Department of Anesthesiology, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Jukka O
authors.initials: JO
authors.lastname: Räsänen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000758:Anesthesia; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008170:Lung Compliance; D008171:Lung Diseases / Q000601:surgery* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage / Q000097:blood; D010865:Pilot Projects; D011175:Positive-Pressure Respiration / Q000379:methods*; D001261:Pulmonary Atelectasis / Q000517:prevention & control*; D056152:Respiratory Rate; D013908:Thoracotomy; D013990:Tidal Volume; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Airway pressure release ventilation; Anesthesia ventilation; Lung resection; Lung surgery; Postoperative pulmonary complications; Protective ventilation; Pulmonary atelectasis; Thoracic surgery