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British Journal of Anaesthesia, 2002, Vol. 88, No. 1 56-60
© 2002 The Board of Management and Trustees of the British Journal of Anaesthesia

Clinical Investigations

Intrinsic positive end-expiratory pressure during one-lung ventilation of patients with pulmonary hyperinflation. Influence of low respiratory rate with unchanged minute volume{dagger}

L. L. Szegedi*,1, L. Barvais2, Y. Sokolow2, J. C. Yernault2 and A. A. d'Hollander3

1Ghent University Hospital, Ghent, 2Erasme University Hospital, 3Free University of Brussels, Brussels, Belgium*Corresponding author: Department of Anaesthesiology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium

{dagger} Presented in part at the Annual Congress of the European Society of Anaesthesiologists, Lausanne, Switzerland, May 6, 1997.

Background. We measured lung mechanics and gas exchange during one-lung ventilation (OLV) of patients with chronic obstructive pulmonary disease, using three respiratory rates (RR) and unchanged minute volume.

Methods. We studied 15 patients about to undergo lung surgery, during anaesthesia, and placed in the lateral position. Ventilation was with constant minute volume, inspiratory flow and FIO2. For periods of 15 min, RR of 5, 10, and 15 bpm were applied in a random sequence and recordings were made of lung mechanics and an arterial blood gas sample was taken. Data were analysed with the repeated measures ANOVA and paired t-test with Bonferroni correction.

Results. PaO2 changes were not significant. At the lowest RR, PaCO2 decreased (from 42 (SD 4) mm Hg at RR 15–41 (4) mm Hg at RR 10 and 39 (4) mm Hg at RR 5, P<0.01), and end-tidal carbon dioxide increased (from 33 (5) mm Hg at RR 15 to 35 (5) mm Hg at RR 10 and 36 (6) mm Hg at RR 5, P<0.01). Intrinsic positive end-expiratory pressure (PEEPi) was reduced even with larger tidal volumes (from 6 (4) cm H2O at RR 15–5 (4) cm H2O at RR 10, and 3 (3) cm H2O at RR 5, P<0.01), most probably caused by increased expiratory time at the lowest RR.

Conclusion. A reduction in RR reduces PEEPi and hypercapnia during OLV in anaesthetized patients with chronic obstructive lung disease.

Br J Anaesth 2002; 88: 56–60


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