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BJA Advance Access originally published online on February 27, 2008
British Journal of Anaesthesia 2008 100(4):549-559; doi:10.1093/bja/aen021
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

One-lung ventilation induces hyperperfusion and alveolar damage in the ventilated lung: an experimental study

A. Kozian1,2, T. Schilling1,2,*, F. Fredén3, E. Maripuu4, C. Röcken5, C. Strang1,2, T. Hachenberg1 and G. Hedenstierna2

1 Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, D-39120 Magdeburg, Germany
2 Institute of Medical Sciences
3 Department of Anaesthesiology and Intensive Care Medicine
4 Department of Hospital Physics, Uppsala University Hospital, Uppsala, Sweden
5 Institute of Pathology, Charité University Hospital, Berlin, Germany

* Corresponding author: Department of Anaesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Leipziger Str. 44, D-39120 Magdeburg, Germany. E-mail: thomas.schilling{at}med.ovgu.de

Background: One-lung ventilation (OLV) increases mechanical stress in the lung and affects ventilation and perfusion (V, Q). There are no data on the effects of OLV on postoperative V/Q matching. Thus, this controlled study evaluates the influence of OLV on V/Q distribution in a pig model using a gamma camera technique [single-photon emission computed tomography (SPECT)] and relates these findings to lung histopathology after OLV.

Methods: Eleven anaesthetized and ventilated pigs (VT=10 ml kg–1, FIO2=0.40, PEEP=5 cm H2O) were studied. After lung separation, OLV and thoracotomy were performed in seven pigs (OLV group). During OLV and in a two-lung ventilation (TLV), control group (n=4) ventilation settings remained unchanged. SPECT with 81mKr (ventilation) and 99mTc-labelled macro-aggregated albumin (perfusion) was performed before, during, and 90 min after OLV/TLV. Finally, lung tissue samples were harvested and examined for alveolar damage.

Results: OLV affected ventilation and haemodynamic variables, but there were no differences between the OLV group and the control group before and after OLV/TLV. SPECT revealed an increase of perfusion in the dependent lung compared with baseline (49–56%), and a corresponding reduction of perfusion (51–44%) in non-dependent lungs after OLV. No perfusion changes were observed in the control group. This resulted in increased low V/Q regions and a shift of V/Q areas to 0.3–0.5 (10–0.5–10–0.3) in dependent lungs of OLV pigs and was associated with an increased diffuse alveolar damage score.

Conclusions: OLV in pigs results in a substantial V/Q mismatch, hyperperfusion, and alveolar damage in the dependent lung and may thus contribute to gas exchange impairment after thoracic surgery.

Keywords: lung, blood flow; lung, damage; surgery, thoracic; ventilation, one-lung; ventilation, ventilation-perfusion


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