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BJA Advance Access published online on June 24, 2005
British Journal of Anaesthesia, 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
Accepted April 12, 2005

Laboratory Investigation

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

P. Michelet 1*, A. Roch 1, D. Brousse 2, X.-B. D'Journo 3, F. Bregeon 4, D. Lambert 1, G. Perrin 1, L. Papazian 5, P. Thomas 3, J.-P. Carpentier 2, and J.-P. Auffray 1

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 Laboratoire de Physiologie Respiratoire, UPRES EA 2201, Université de la Méditerranée, France
5 Service de Réanimation Médicale, Hôpitaux Sud, Marseille, France

* To whom correspondence should be addressed.
P. Michelet, E-mail: pierre.michelet{at}mail.ap-hm.fr


  Abstract

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 Pao2/Fio2 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.

Keywords: complications, hypoxaemia; model, pig; nitric oxide; ventilation, one lung; ventilation, possible end-expiratory pressure.
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