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By TEE evaluation of left lateral position the hemodynamic changes of positive end-expiratory pressure in patients with single - lung ventilation with low tidal volume

Author: ChenGuangJun
Tutor: YeTieHu
School: Peking Union Medical College , China
Course: Anesthesiology
Keywords: By transesophageal echocardiography Left lateral position Low tidal volume Positive end-expiratory pressure One-lung ventilation
CLC: R614
Type: Master's thesis
Year: 2008
Downloads: 37
Quote: 0
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Abstract


Background: the current trend of one-lung ventilation with low tidal volume , PEEP , to reduce acute lung injury incidence . This technology with traditional tidal volumes (8-12 ml / kg) compared to one-lung ventilation technology , while reducing intraoperative and postoperative lung bruised , to maintain the normal exchange of oxygen and carbon dioxide discharge , to maintain a relatively normal ventilation function , so more and more clinical center uses . However, this new technology of ventilation in the lateral position thoracotomy hemodynamic yet not been reported . Objective: application TEE evaluation of the left lateral decubitus position thoracotomy patients barotropic one-lung ventilation with low tidal volume end-expiratory hemodynamic changes relative supine lung ventilation . Methods : 10 cases of ASA Ⅰ - Ⅱ grade elective left lateral position a thoracotomy lobectomy were enrolled in the study . After induction of general anesthesia with low tidal volume end-expiratory positive pressure ventilation , tidal volume 6ml/kg PEEP to 6 cmH 2 O , respiratory rate 12 ~ 16/min . Maintain EtCO2 35-40 mmHg, SPO 2 > 96%, and continue until the end of the study observed . 30min ( approximately central venous puncture after 15min) measured after induction of anesthesia the patient supine lung ventilation HR , BP , CVP, application TEE by the middle of the stomach and the left ventricle short axis measuring EF , SV , CO , CI , the SI , ESV, EDV, DFS and SVR. Supine test is completed will move the patient to the left lateral decubitus position , the right side of the open- chest one-lung ventilation to thoracotomy after about 15 minutes when measured in the same manner as the above parameters , the withdrawal of esophageal probe after the end of the measurement data to the end of the experiment . Results: In the low tidal volume end-expiratory positive pressure ventilation mode , SV and SI in the left lateral position one-lung ventilation than supine lung ventilation was significantly higher ( P <0.05 ) , but the HR, SBP, DBP , and CVP no significant difference ; and EF, the CO. , CI , LVESV , LVEDV LVDFS and no significant difference in SVR . Conclusion: The low tidal volume end-expiratory positive pressure ventilation mode , and supine lung ventilation compared with one-lung ventilation of the left lateral position does not affect the patient's cardiac function and hemodynamics , SV and SI was significantly higher, but EF, CO, CI no significant difference .

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