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BJA Advance Access originally published online on June 24, 2005
British Journal of Anaesthesia 2005 95(2):267-273; doi:10.1093/bja/aei178
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2005. All rights reserved. For Permissions, please e-mail: journal.permissions@oupjournals.org

Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation

P. Michelet1,*, A. Roch1, D. Brousse2, X.-B. D'Journo3, F. Bregeon5, D. Lambert1, G. Perrin1, L. Papazian4, P. Thomas3, J.-P. Carpentier2 and J.-P. Auffray1

1 Département d'Anesthésie Réanimation, Hôpitaux Sud, Marseille, France. 2 Service de Réanimation, Hôpital d'Instruction des Armées Laveran, Marseille, France. 3 Service de Chirurgie Thoracique, Hôpitaux Sud, Marseille, France. 4 Service de Réanimation Médicale, Hôpitaux Sud, Marseille, France. 5 Laboratoire de Physiologie Respiratoire, UPRES EA 2201, Université de la Méditerranée, France

* Corresponding author: Réanimation Polyvalente, Hôpital Sainte-Marguerite, 13274 Marseille Cedex 9, France. E-mail: pierre.michelet{at}mail.ap-hm.fr

Background. One-lung ventilation-related hypoxaemia (OLV-RH) can occur in patients with healthy lungs. In this case, PEEP frequently improves oxygenation. The aim of this study was to determine, in a healthy lung model of OLV, whether the increase in PEEP improved oxygenation and whether the mechanisms involved include both inspiratory lung recruitment and an end-expiratory lung volume increase. Since inhaled nitric oxide (iNO) may have a synergistic effect on oxygenation in the case of PEEP-induced recruitment, their association was also tested.

Methods. Twenty pigs were studied during open-chest, left OLV. Arterial blood gases and haemodynamic variables were measured at different levels of PEEP (0, 5, 10 and 15 cm H2O) applied in random order with or without iNO 4 p.p.m. Pressure–volume curves were measured at each level of PEEP.

Results. PEEP5 and PEEP10 improved / ratio (P<0.005) and shunt (P<0.005) regardless of the presence of iNO. PEEP15 improved oxygenation and shunt only when it was associated with iNO (P<0.001). Whereas PEEP5, PEEP10 and PEEP15 were associated with a significant increase in end-expiratory volume (P<0.001), only PEEP5 and PEEP10 were associated with continuous lung volume recruitment (P<0.01). Moreover, PEEP15 induced a significant decrease in linear compliance (P<0.001).

Conclusions. In a healthy porcine lung model of OLV-RH, moderate PEEP can improve oxygenation. This effect implies both expiratory and inspiratory pulmonary recruitment. Co-administration of 4 p.p.m. iNO was ineffective.


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