Abstract：
BACKGROUND: For patients receiving one lung ventilation in thoracic surgery, numerous studies have proved the superiority of lung protective ventilation of low tidal volume combined with recruitment maneuvers (RM) and individualized PEEP. However, RM may lead to overinflation which aggravates lung injury and intrapulmonary shunt. According to CT results, atelectasis usually forms in gravity dependent lung regions, regardless of body position. So, during anesthesia induction in supine position, atelectasis usually forms in the dorsal parts of lungs, however, when patients are turned into lateral decubitus position, collapsed lung tissue in the dorsal parts would reexpand, while atelectasis would slowly reappear in the lower flank of the lung. We hypothesize that applying sufficient PEEP without RM before the formation of atelectasis in the lower flank of the lung may beas effective to prevent atelectasis and thus improve oxygenation as applying PEEP with RM.
METHODS: A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized totwo parallel groups. For all patients, one lung ventilation is initiated the right after patients are turned into lateral decubitus position. For patients in the study group, individualized PEEP titration is started the moment one lung ventilation is started, while patients in the control group will receive a recruitment maneuver followed by individualized PEEP titration after initiation of one lung ventilation. The primary endpoint will be oxygenation index measured at T4. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators.
CONCLUSIONS: Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we\'re going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that may be conductive to improving intraoperative oxygenation and avoiding the detrimental effects of RM for patients receiving one lung ventilation.
BACKGROUND: www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024.
METHODS: A total of 84 patients scheduled for elective pulmonary lobe resection necessitating one lung ventilation will be recruited and randomized totwo parallel groups. For all patients, one lung ventilation is initiated the right after patients are turned into lateral decubitus position. For patients in the study group, individualized PEEP titration is started the moment one lung ventilation is started, while patients in the control group will receive a recruitment maneuver followed by individualized PEEP titration after initiation of one lung ventilation. The primary endpoint will be oxygenation index measured at T4. Secondary endpoints will include intrapulmonary shunt, respiratory mechanics, PPCs, and hemodynamic indicators.
CONCLUSIONS: Numerous previous studies compared the effects of individualized PEEP applied alone with that applied in combination with RM on oxygenation index, PPCs, intrapulmonary shunt and respiratory mechanics after atelectasis was formed in patients receiving one lung ventilation during thoracoscopic surgery. In this study, we will apply individualized PEEP before the formation of atelectasis while not performing RM in patients allocated to the study group, and then we\'re going to observe its effects on the aspects mentioned above. The results of this trial will provide a ventilation strategy that may be conductive to improving intraoperative oxygenation and avoiding the detrimental effects of RM for patients receiving one lung ventilation.
BACKGROUND: www.Chictr.org.cn ChiCTR2400080682. Registered on February 5, 2024.
摘要：
背景：对于胸外科手术中接受单肺通气的患者，大量研究已经证明了低潮气量肺保护性通气结合招募动作(RM)和个体化PEEP的优越性。然而,RM可能导致过度膨胀，从而加重肺损伤和肺内分流。根据CT结果,肺不张通常形成在重力依赖性肺区域，不管身体的位置。所以,在仰卧位麻醉诱导期间，肺不张通常在肺的背侧形成，然而,当患者变成侧卧位时，背部塌陷的肺组织会重新扩张，而肺不张会慢慢地在肺的下腹部再次出现。我们假设，在肺下腹肺不张形成之前，在没有RM的情况下应用足够的PEEP可能会有效预防肺不张，从而改善氧合。
方法：共招募84名需要单肺通气的择期肺叶切除术患者，随机分为两个平行组。对于所有患者来说，患者转为侧卧位后，右肺开始通气。对于研究组的患者，个性化的PEEP滴定开始一肺通气开始，而对照组的患者将在开始单肺通气后接受招募策略，然后进行个性化PEEP滴定。主要终点将是在T4测量的氧合指数。次要终点将包括肺内分流，呼吸力学,PPCs,和血液动力学指标。
结论：许多先前的研究比较了单独应用和与RM联合应用的个体化PEEP对氧合指数的影响，PPCs,在胸腔镜手术中接受单肺通气的患者形成肺不张后的肺内分流和呼吸力学。在这项研究中,我们将在肺不张形成之前应用个性化PEEP，而不在分配给研究组的患者中进行RM，然后我们将观察它对上述方面的影响。该试验的结果将提供一种通气策略，该策略可能有助于改善术中氧合并避免RM对接受单肺通气的患者的有害影响。
背景：www.Chictr.org.cnChiCTR2400080682。2024年2月5日注册。
方法：共招募84名需要单肺通气的择期肺叶切除术患者，随机分为两个平行组。对于所有患者来说，患者转为侧卧位后，右肺开始通气。对于研究组的患者，个性化的PEEP滴定开始一肺通气开始，而对照组的患者将在开始单肺通气后接受招募策略，然后进行个性化PEEP滴定。主要终点将是在T4测量的氧合指数。次要终点将包括肺内分流，呼吸力学,PPCs,和血液动力学指标。
结论：许多先前的研究比较了单独应用和与RM联合应用的个体化PEEP对氧合指数的影响，PPCs,在胸腔镜手术中接受单肺通气的患者形成肺不张后的肺内分流和呼吸力学。在这项研究中,我们将在肺不张形成之前应用个性化PEEP，而不在分配给研究组的患者中进行RM，然后我们将观察它对上述方面的影响。该试验的结果将提供一种通气策略，该策略可能有助于改善术中氧合并避免RM对接受单肺通气的患者的有害影响。
背景：www.Chictr.org.cnChiCTR2400080682。2024年2月5日注册。
