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24 November 2022 : Clinical Research  

[In Press] Effect of Positive End-Expiratory Pressure (PEEP) Titration in Elderly Patients Undergoing Lobectomy

Wenyu Yao1AE, Bo Yang2B, Wenlong Wang3B, Qian Han1D, Fenghai Liu4D, Shiqiang Shan1G, Chao Wang1E, Mengliang Zheng1F

DOI: 10.12659/MSM.938225

Med Sci Monit In Press; DOI: 10.12659/MSM.938225  

Available online: 2022-11-24, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Currently, one-lung ventilation in thoracoscopic lobectomy adopts mostly a protective ventilation mode, which includes low tidal volume (a tidal volume of 6 mL/kg predicted body weight), positive end-expiratory pressure (PEEP), and intermittent lung inflation. However, there is no clear conclusion regarding the value of PEEP in elderly patients undergoing lobectomy.
MATERIAL AND METHODS
Fifty patients who underwent video-assisted thoracoscopic unilateral lobectomy, aged 65 to 78 years, with a body mass index of 18 to 29 kg/m² and ASA grades I to III, were randomly divided into 2 groups (n=25 each): optimal oxygenation titration group (group O) and optimal compliance titration group (group C). Mean arterial pressure (MAP), heart rate (HR), and central venous pressure (CVP) were recorded in both groups at different time points. The radial artery blood samples were collected at 3 time points for blood gas analysis, and the void volume/tidal volume ratio was calculated. The peak airway pressure and PEEP values were recorded at 4 min after the completion of one-lung ventilation titration (T2), and the driving pressure was calculated.
RESULTS
The best PEEP value of titration in the best compliance group was lower than that of the best oxygenation method, the peak was lower, and the dynamic lung compliance was higher; however, this had no effect on MAP and HR. The CVP was lower than optimal oxygenation at T2.
CONCLUSIONS
Dynamic lung compliance-guided PEEP titration improved lung function in elderly patients undergoing lobectomy.

Keywords: Thoracic Surgery, Video-Assisted; Aged; Respiration, Artificial; Respiratory Function Tests

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Dinah V. Parums
Science Editor, Medical Science Monitor, International Scientific Information, Inc., Melville, NY, USA

DOI: 10.12659/MSM.939088

Med Sci Monit 2022; 28:e939088

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750