PDF(Pubmed)
Abstract：
BACKGROUND: A significant reduction in regional cerebral oxygen saturation (rSO2) is commonly observed during one-lung ventilation (OLV), while positive end-expiratory pressure (PEEP) can improve oxygenation. We compared the effects of three different PEEP levels on rSO2, pulmonary oxygenation, and hemodynamics during OLV.
METHODS: Forty-three elderly patients who underwent thoracoscopic lobectomy were randomly assigned to one of six PEEP combinations which used a crossover design of 3 levels of PEEP-0 cmH2O, 5 cmH2O, and 10 cmH2O. The primary endpoint was rSO2 in patients receiving OLV 20 min after adjusting the PEEP. The secondary outcomes included hemodynamic and respiratory variables.
RESULTS: After exclusion, thirty-six patients (36.11% female; age range: 60-76 year) were assigned to six groups (n = 6 in each group). The rSO2 was highest at OLV(0) than at OLV(10) (difference, 2.889%; [95% CI, 0.573 to 5.204%]; p = 0.008). Arterial oxygen partial pressure (PaO2) was lowest at OLV(0) compared with OLV(5) (difference, -62.639 mmHg; [95% CI, -106.170 to -19.108 mmHg]; p = 0.005) or OLV(10) (difference, -73.389 mmHg; [95% CI, -117.852 to -28.925 mmHg]; p = 0.001), while peak airway pressure (Ppeak) was lower at OLV(0) (difference, -4.222 mmHg; [95% CI, -5.140 to -3.304 mmHg]; p < 0.001) and OLV(5) (difference, -3.139 mmHg; [95% CI, -4.110 to -2.167 mmHg]; p < 0.001) than at OLV(10).
CONCLUSIONS: PEEP with 10 cmH2O makes rSO2 decrease compared with 0 cmH2O. Applying PEEP with 5 cmH2O during OLV in elderly patients can improve oxygenation and maintain high rSO2 levels, without significantly increasing peak airway pressure compared to not using PEEP.
BACKGROUND: Chinese Clinical Trial Registry ChiCTR2200060112 on 19 May 2022.
METHODS: Forty-three elderly patients who underwent thoracoscopic lobectomy were randomly assigned to one of six PEEP combinations which used a crossover design of 3 levels of PEEP-0 cmH2O, 5 cmH2O, and 10 cmH2O. The primary endpoint was rSO2 in patients receiving OLV 20 min after adjusting the PEEP. The secondary outcomes included hemodynamic and respiratory variables.
RESULTS: After exclusion, thirty-six patients (36.11% female; age range: 60-76 year) were assigned to six groups (n = 6 in each group). The rSO2 was highest at OLV(0) than at OLV(10) (difference, 2.889%; [95% CI, 0.573 to 5.204%]; p = 0.008). Arterial oxygen partial pressure (PaO2) was lowest at OLV(0) compared with OLV(5) (difference, -62.639 mmHg; [95% CI, -106.170 to -19.108 mmHg]; p = 0.005) or OLV(10) (difference, -73.389 mmHg; [95% CI, -117.852 to -28.925 mmHg]; p = 0.001), while peak airway pressure (Ppeak) was lower at OLV(0) (difference, -4.222 mmHg; [95% CI, -5.140 to -3.304 mmHg]; p < 0.001) and OLV(5) (difference, -3.139 mmHg; [95% CI, -4.110 to -2.167 mmHg]; p < 0.001) than at OLV(10).
CONCLUSIONS: PEEP with 10 cmH2O makes rSO2 decrease compared with 0 cmH2O. Applying PEEP with 5 cmH2O during OLV in elderly patients can improve oxygenation and maintain high rSO2 levels, without significantly increasing peak airway pressure compared to not using PEEP.
BACKGROUND: Chinese Clinical Trial Registry ChiCTR2200060112 on 19 May 2022.
摘要：
背景：在单肺通气（OLV）期间通常观察到局部脑氧饱和度（rSO2）显着降低，呼气末正压（PEEP）可以改善氧合。我们比较了三种不同PEEP水平对rSO2，肺氧合，OLV期间的血流动力学。
方法：将43例接受胸腔镜肺叶切除术的老年患者随机分配到6种PEEP组合中的一种，该组合使用3种PEEP-0cmH2O水平的交叉设计，5cmH2O，和10cmH2O。主要终点是调整PEEP后20分钟接受OLV的患者的rSO2。次要结果包括血液动力学和呼吸变量。
结果：排除后，36例患者(36.11%为女性;年龄范围:60-76岁)被分为6组(每组n=6).OLV(0)时的rSO2比OLV(10)时最高(差异，2.899%；[95%CI，0.573至5.204%]；p=0.008）。与OLV（5）相比，OLV（0）时的动脉氧分压（PaO2）最低（差异，-62.639mmHg；[95％CI，-106.170至-19.108mmHg]；p=0.005）或OLV（10）（差异，-73.389mmHg；[95%CI，-117.852至-28.925mmHg]；p=0.001），而在OLV（0）时，峰值气道压（Ppeak）较低（差异，-4.222mmHg；[95％CI，-5.140至-3.304mmHg]；p<0.001）和OLV（5）（差异，-3.139mmHg；[95%CI，-4.110至-2.167mmHg]；p<0.001）比OLV（10）。
结论：与0cmH2O相比，10cmH2O的PEEP使rSO2降低。在老年患者OLV期间应用PEEP与5cmH2O可以改善氧合并维持较高的rSO2水平，与不使用PEEP相比，没有显着增加气道峰值压力。
背景：中国临床试验注册中心ChiCTR2200060112，2022年5月19日。
方法：将43例接受胸腔镜肺叶切除术的老年患者随机分配到6种PEEP组合中的一种，该组合使用3种PEEP-0cmH2O水平的交叉设计，5cmH2O，和10cmH2O。主要终点是调整PEEP后20分钟接受OLV的患者的rSO2。次要结果包括血液动力学和呼吸变量。
结果：排除后，36例患者(36.11%为女性;年龄范围:60-76岁)被分为6组(每组n=6).OLV(0)时的rSO2比OLV(10)时最高(差异，2.899%；[95%CI，0.573至5.204%]；p=0.008）。与OLV（5）相比，OLV（0）时的动脉氧分压（PaO2）最低（差异，-62.639mmHg；[95％CI，-106.170至-19.108mmHg]；p=0.005）或OLV（10）（差异，-73.389mmHg；[95%CI，-117.852至-28.925mmHg]；p=0.001），而在OLV（0）时，峰值气道压（Ppeak）较低（差异，-4.222mmHg；[95％CI，-5.140至-3.304mmHg]；p<0.001）和OLV（5）（差异，-3.139mmHg；[95%CI，-4.110至-2.167mmHg]；p<0.001）比OLV（10）。
结论：与0cmH2O相比，10cmH2O的PEEP使rSO2降低。在老年患者OLV期间应用PEEP与5cmH2O可以改善氧合并维持较高的rSO2水平，与不使用PEEP相比，没有显着增加气道峰值压力。
背景：中国临床试验注册中心ChiCTR2200060112，2022年5月19日。
