Published in:
01-12-2019 | Thoracic Anesthesia (T Schilling, Section Editor)
Positive End-Expiratory Pressure (PEEP), Tidal Volume, or
Alveolar Recruitment: Which One Does Matter in One-Lung Ventilation?
Authors:
Taner Abdullah, Mert Şentürk
Published in:
Current Anesthesiology Reports
|
Issue 4/2019
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Abstract
Purpose of Review
This review attempts to focus on protective ventilation approaches
during one-lung ventilation (OLV) and will summarize recent findings.
Recent Findings
Recent studies have demonstrated the importance of low tidal volume
(low TV) and reduced driving pressure during OLV. Along with low TV, correct use
of positive end-expiratory pressure (PEEP) seems to have a vital role in terms
of protecting the ventilated lung. PEEP decremental trial and the use of
electrical impedance tomography are prominent techniques for individualizing the
PEEP. The use of alveolar recruitment maneuvers (ARMs) is furthermore
recommended. Nevertheless, there are several studies published considering
negative effects of ARM.
Summary
Although small tidal volumes are highly recommended during OLV, it
is not possible for low TV to be beneficial unless an optimal PEEP is applied.
Use of ARM is still under debate. Yet, it seems to be the only way for
preventing injurious tidal recruitment, which is known to be harmful to the
lungs.