Application value of open lung strategy in titration of positive end-expiratory pressure in radical esophagectomy
Song Zhengjie1, Yuan Feng2, Cao Peng1, Cheng Jinglin2, Li Zhisong2
1The Second Clinical Medicine College, Zhengzhou University, Zhengzhou 450014, China； 2Department of Anesthesiology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou 450014, China
Abstract：ObjectiveTo explore the application value of open lung strategy (OLS) in titration of positive end-expiratory pressure (PEEP) in patients undergoing radical esophagectomy. MethodsFrom February 2019 to February 2020, 60 patients who planned to undergo radical resection of esophageal carcinoma under optional one-lung ventilation (OLV) in the Department of Thoracic Surgery, The Second Affiliated Hospital of Zhengzhou University, were randomly divided into experimental group (n=30) and control group (n=30) according to random number table method. In OLV, 5cmH2O (1cmH2O=0.098kPa) was taken as the initial PEEP value in both groups. OLS was performed in the experimental group after hemodynamic stability, the highest compliance PEEP was detected and the catheter was applied until the end of the operation. In the control group, endotracheal catheter was extracted at PEEP=5cmH2O until the end of operation. Airway plateau pressure (Pplat), airway peak pressure (Ppeak), and lung dynamic compliance (Cdyn) were recorded in the two groups after intubation (T1), OLV immediate (T2), OLS 30min after OLS application (T3), OLS 60min after OLS application (T4). Arterial blood was extracted at the above time points for blood gas analysis, arterial oxygen partial pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) were recorded, and the oxygenation index (OI) was calculated. Repeated measurement analysis of variance was used to compare oxygenation and respiratory dynamics indexes between the two groups at different time points above. ResultsFrom T1 to T4, there were no significant differences in PaCO2 between the experimental group ［(38.70±2.93)mmHg, (38.89±3.54)mmHg, (39.19±3.43)mmHg, (39.54±3.17)mmHg］ and the control group ［(39.72±3.19)mmHg, (40.35±3.71)mmHg, (39.66±3.47)mmHg, (39.54±3.42)mmHg］ (F=1.67, 2.15, 0.27, 0.04, all P＞0.05). Compare the OI, Pplat, Ppeak and Cdyn of two groups from T1 to T4, there were significant differences （F=13.29, 15.02, 7.05, 33.62, all P＜0.05）. At T3 and T4, OI ［(259.30±30.68)mmHg, (267.39±33.81)mmHg］, Pplat［ (17.98±2.56)cmH2O, (17.09±2.87)cmH2O］, Ppeak［(27.74±4.68)cmH2O, (27.27±3.03)cmH2O］, Cdyn［(33.44±2.74)ml/cmH2O, (35.35±3.42)ml/cmH2O］ in experimental group were significantly increased when compared with those of the control group［(238.00±31.02)mmHg, (234.83±34.90)mmHg, (15.63±3.24)cmH2O, (14.92±2.64)cmH2O, (25.27±4.35)cmH2O, (25.60±2.72)cmH2O, (27.70±3.54)ml/cmH2O, (28.20±3.69)ml/cmH2O］ (F=7.15, 13.47, 9.75, 9.20, 4.48, 5.03, 49.23, 60.51，all P＜0.05). At T3 and T4,OI, Pplat, Ppeak, Cdyn in experimental group were significantly increased when compared with those at the T2 ［(238.00±31.02)mmHg, (13.89±3.16)cmH2O, (22.37±2.11)cmH2O, (28.16±3.15)ml/cmH2O］ (t=-2.43, -3.35, -5.74, -4.48, -6.82, -6.28, -5.55, -7.56，all P＜0.05). ConclusionsThe oxygenation index of patients undergoing radical resection of esophageal cancer under general anesthesia is decreased. The protective ventilation strategy of using OLS to titrate individualized PEEP could significantly improve oxygenation and increase lung compliance, which is conducive to the protective effect of lung ventilation.
宋正杰 袁峰 曹鹏 程静林 李治松. 肺开放策略减量滴定呼气末正压在食管癌根治术中的应用价值[J]. 中华诊断学电子杂志, 2021, 9(2): 121-126.
Song Zhengjie1, Yuan Feng2, Cao Peng1, Cheng Jinglin2, Li Zhisong2. Application value of open lung strategy in titration of positive end-expiratory pressure in radical esophagectomy. zhzdx, 2021, 9(2): 121-126.
