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1 From the Department of Anesthesiology, Erasme University Hospital, Free University of Brussels, Belgium
2 From the Department of Chest Medicine, Erasme University Hospital, Free University of Brussels, Belgium
3 From the Department of Thoracic Surgery, Erasme University Hospital, Free University of Brussels, Belgium
Objective: To detect and to quantify intrinsic positive end-expiratory pressure (PEEPi) during thoracic surgery in the dependent lung of patients intubated with a double-lumen endotracheal tube (DLT) in the lateral position.
Methods: Twenty consecutive patients undergoing elective pulmonary resection were anesthetized, paralyzed, and intubated with a DLT. Their lungs were ventilated (Siemens Servo 900 C ventilator; Siemens Elevna; Solna, Sweden) with constant inspiratory flow. Fraction of inspired oxygen, tidal volume (10 mL/kg), frequency (10/min), and inspiratory time/total time (0.33) were kept constant during the study. PEEPi and ventilatory data were measured in the dependent lung in the supine then in the lateral position with a closed hemithorax. The obtained data were analyzed according to the presence (group PH) or absence (group N) of pulmonary hyperinflation determined from the preoperative pulmonary function data as higher than 120% of predicted value of functional residual capacity (FRC) and residual volume (RV).
Data analysis: In the dependent lung of patients in group PH (n=11), PEEPi was present in the supine (n=8) and in the lateral (n=11) positions in the range of 1 to 10 cm H2O. In group N (n=9), PEEPi was detected in one patient and only in the supine position. In the whole group of 20 patients, the preoperative value of FRC (% predicted) and RV (% predicted) was statistically significantly correlated to the presence of PEEPi, whereas the preoperative FEV1 (% predicted) was poorly related to PEEPi in both positions. There was no significant correlation between the value of PaCO2 and PEEPi during one-lung ventilation (OLV) but patients in group PH had a significantly higher PaCO2 during OLV than group N (p=0.012).
Conclusions: In patients with chronic obstructive lung disease and pulmonary hyperinflation, PEEPi occurs commonly during the period of OLV and only occasionally in patients with normal lungs. As the ventilatory pattern, the size of DLT, and the side of surgery were similar in the two groups of patients, we conclude that the occurrence of PEEPi in our patients was influenced mainly by the preexisting pulmonary hyperinflation and airflow obstruction.
Key Words: anesthesia • lung surgery • mechanical ventilation • positive end-expiratory pressure
Submitted on November 29, 1995
Accepted on February 28, 1996
This article has been cited by other articles:
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  P. Slinger, A. Seymour, B. Prasad, and R. McKenzie Audit of double-lumen endobronchial intubation Br. J. Anaesth., June 1, 2005; 94(6): 861 - 861. [Full Text] [PDF]
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L. L. Szegedi, L. Barvais, Y. Sokolow, J. C. Yernault, and A. A. d'Hollander Intrinsic positive end-expiratory pressure during one-lung ventilation of patients with pulmonary hyperinflation. Influence of low respiratory rate with unchanged minute volume{dagger} Br. J. Anaesth., January 1, 2002; 88(1): 56 - 60. [Abstract] [Full Text] [PDF]
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