title: Effects of a preemptive alveolar recruitment strategy on arterial oxygenation during one-lung ventilation with different tidal volumes in patients with normal pulmonary function test.
abstract: BACKGROUND
  Hypoxemia during one-lung ventilation (OLV) remains a major concern. The present study compared the effect of alveolar recruitment strategy (ARS) on arterial oxygenation during OLV at varying tidal volumes (Vt) with or without positive end-expiratory pressure (PEEP).
  
  
  METHODS
  In total, 120 patients undergoing wedge resection by video assisted thoracostomy were randomized into four groups comprising 30 patients each: those administered a 10 ml/kg tidal volume with or without preemptive ARS (Group H and Group H-ARS, respectively) and those administered a 6 ml/kg tidal volume and a 8 cmH2O PEEP with or without preemptive ARS (Group L and Group L-ARS, respectively). ARS was performed using pressure-controlled ventilation with a 40 cmH2O plateau airway pressure and a 15 cmH2O PEEP for at least 10 breaths until OLV began.
  
  
  RESULTS
  Preemptive ARS significantly improved the PaO2/FiO2 ratio compared to the groups that did not receive ARS (P < 0.05). The H-ARS group showed a highest PaO2/FiO2 ratio during OLV, the L-ARS and H groups showed similarly improved arterial oxygenation, which was significantly higher than in group L (P < 0.05). The plateau airway pressure in group H-ARS was significantly higher than in group L-ARS (P < 0.05).
  
  
  CONCLUSIONS
  Preemptive ARS can improve arterial oxygenation during OLV. Furthermore, a 6 ml/kg tidal volume combined with 8 cmH2O PEEP after preemptive ARS may reduce the risk of pulmonary injury caused by high tidal volume during one-lung ventilation in patients with normal pulmonary function.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Jong Dal
authors.initials: JD
authors.lastname: Jung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Sang Hun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University School of Medicine, Gwangju, Korea. ; Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Byung Sik
authors.initials: BS
authors.lastname: Yu
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chosun University Hospital, Gwangju, Korea.
authors.forename: Hye Ji
authors.initials: HJ
authors.lastname: Kim
keywords: Alveolar recruitment; One-lung ventilation; Oxygenation; PEEP; Preemptive; Tidal volume