ONE-LUNG VENTILATION AND ITS ROLE IN POSTOPERATIVE PULMONARY MORBIDITY FOLLOWING LUNG SURGERY
DOI:
https://doi.org/10.55302/vyz4k862Keywords:
atelectasis, one-lung ventilation, pneumonia, pulmonary complications, respiratory failureAbstract
Introduction: On one hand, one-lung ventilation is a method intended to improve surgical access while guaranteeing enough oxygenation and is often required for thoracic surgery. On the other hand, one-lung ventilation increases the risk of pulmonary complications both during and after surgery. Because they raise morbidity, lengthen hospital stays and may have negative consequences, these complications are clinically significant. Our evaluation's goal was to determine the frequency and predictors of these complications, which are crucial for enhancing patient care and maximizing surgical results.
Material and Methods:In this retrospective analysis, we assessed 80 elective patients who had one-lung ventilation and lung resection as a result of cancer. The anesthetic protocol for all patients followed a standardized approach, ensuring consistency in perioperative management. The defined inclusion and exclusion criteria were used to determine which patients were included in the study. We looked at pulmonary complications after surgery, such as respiratory insufficiency, pneumonia and atelectasis in the first week after surgery.
Results: The study included 80 patients, with a postoperative pulmonary complication rate of 30.0%. Atelectasis, pneumonia and respiratory failure were the most commonly observed complications, with pneumonia being the leading cause. Pulmonary complications were significantly more prevalent in patients undergoing lobectomy (79.2%) and in those over 60 years of age (75.0%). Male gender, higher BMI (>25), reduced FEV1% (<70) and FVC (<70) significantly increased the risk of pulmonary complications. Although oxygen saturation (SpO2%) dropped during one-lung ventilation, this was more pronounced on the right side, though without statistical significance.
Conclusion: It is very common for pulmonary complications to happen after thoracic surgery. This is mostly because of the physiological changes that happen in the operating room and the use of one-lung ventilation. These factors significantly impact respiratory mechanics and gas exchange, underscoring the need for vigilant perioperative monitoring and tailored management strategies to mitigate these complications.
Downloads
References
1. Slinger P, Darling G. Preanesthetic assessment for thoracic surgery. In: Slinger P, ed. Principles and Practice of Anesthesia for Thoracic Surgery. Melbourne: Springer; 2011:11-34.
2. Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology 2010;113:1338-1350.
3. Allen MS, Darling GE, Pechet TT, et al. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer: initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg 2006;81:1013-1020.
4. Canet J, Gallart L. Predicting postoperative pulmonary complications in the general population. Curr Opin Anaesthesiol 2013;26:107-115.
5. Shelley, B.G.; McCall, P.J.; Glass, A.; Orzechowska, I.; Klein, A.A.; Association of Cardiothoracic Anaesthesia and collaborators. Association between Anaesthetic Technique and Unplanned Admission to Intensive Care after Thoracic Lung Resection Surgery: The Second Association of Cardiothoracic Anaesthesia and Critical Care (ACTACC) National Audit. Anaesthesia 2019, 74, 1121–1129.
6. Sen, S.; Sen, S.; Sentürk, E.; Kuman, N.K. Postresectional Lung Injury in Thoracic Surgery Pre and Intraoperative Risk Factors: A Retrospective Clinical Study of a Hundred Forty-Three Cases. J. Cardiothorac. Surg. 2010, 5, 62.
7. Traibi, A.; Grigoroiu, M.; Boulitrop, C.; Urena, A.; Masuet-Aumatell, C.; Brian, E.; Stern, J.-B.; Zaimi, R.; Gossot, D. Predictive Factors for Complications of Anatomical Pulmonary Segmentectomies. Interact. Cardiovasc. Thorac. Surg. 2013, 17, 838–844.
8. Khemani RG, Thomas NJ, Venkatachalam V (2012) Comparison of SpO2 to PaO2 based markers of lung disease severity for children with acute lung injury. Crit Care Med 40:1309-1316.
9. Jammer, I.; Wickboldt, N.; Sander, M.; Smith, A.; Schultz, M.J.; Pelosi, P.; Leva, B.; Rhodes, A.; Hoeft, A.; Walder, B.; et al. Standards for Definitions and Use of Outcome Measures for Clinical Effectiveness Research in Perioperative Medicine: European Perioperative Clinical Outcome (EPCO) Definitions: A Statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur. J. Anaesthesiol. 2015, 32, 88–105.
10. Raphael J, Chae A, Feng X, Shotwell MS, Mazzeffi MA, Bollen BA, Pfeil D, Feduska E, Shah AS, Kertai MD. Red Blood Cell Transfusion and Pulmonary Complications: The Society of Thoracic Surgeons Adult Cardiac Surgery Database Analysis. Ann Thorac Surg. 2024 Apr;117(4):839-846.
11. Gavrilovska-Brzanov A., Slaninka Miceska M., Shosholcheva M., Kuzmanovska B., Kartalov A., Mojsova-Mijovska M., Jovanovski-Srceva M., Simeonov R., Brzanov N. “Carboxyhemoglobin and Methemoglobin as Markers of Postoperative Pulmonary Complications“. Journal of Anesthesia and Surgery 2018 May;5(1):61-67.
12. Park M. et al. Driving pressure-guided ventilation and postoperative pulmonary complications in thoracic surgery: A multicenter randomized clinical trial. Br J Anaesth 2023;130:e106–18.
13. Fernandes EO, Teixeira C, da Silva LCC. Thoracic surgery: Risk factors for postoperative complications of lung resection. Rev Assoc Med Bras. 2011;57:292-298.
14. Stephan F, Boucheseiche S, Hollande J, Flahault A, Cheffi A, Bazelly, Bernard et al. Pulmonary complications following lung resection. A comprehensive analysis of incidence and possible risk factors. Chest. 2000;118:1-8.
15. Jammer, I.; Wickboldt, N.; Sander, M.; Smith, A.; Schultz, M.J.; Pelosi, P.; Leva, B.; Rhodes, A.; Hoeft, A.; Walder, B.; et al. Standards for Definitions and Use of Outcome Measures for Clinical Effectiveness Research in Perioperative Medicine: European Perioperative Clinical Outcome (EPCO) Definitions: A Statement from the ESA-ESICM Joint Taskforce on Perioperative Outcome Measures. Eur. J. Anaesthesiol. 2015, 32, 88–105.
16. Marshall C, Marshall B: Site and sensitivity for stimulation of hypoxic pulmonary vasoconstriction. J Appl Physiol 1983;55:711–6.
17. Baar W, Semmelmann A, Knoerlein J, Weber F, Heinrich S, Loop T. Risk Factors for Postoperative Pulmonary Complications Leading to Increased In-Hospital Mortality in Patients Undergoing Thoracotomy for Primary Lung Cancer Resection: A Multicentre Retrospective Cohort Study of the German Thorax Registry. J. Clin. Med. 2022:1;774.
18. Fernandes EO, Teixeira C, da Silva LCC. Thoracic surgery: Risk factors for postoperative complications of lung resection. Rev Assoc Med Bras. 2011;57:292-298.
19. Adde FV, Campos SV, Henrique R, Braga DO, Rodrigues JC. Indications for lung resection surgery and lung transplant in South American children with cystic fibrosis. Paediatr Respir Rev. 2017;25:37-42.
20. Brooks-Brunn JA. Postoperative atelectasis and pneumonia: Risk factors. Am J Crit Care. 1995;4:340-9.
21. Duggan M, Kavanagh BP. Pulmonary atelectasis: A pathogenic perioperative entity. Anesthesiology. 2005;102:838-54.
22. Retamal J, Bergamini BC, Carvalho AR, et al. Non-Lobar atelectasis generates inflammation and structural alveolar injury in the surrounding healthy tissues during mechanical ventilation. Crit Care 2014;18:505.
23. Brunelli A, Anthony WK, Kenneth IB, et al. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013:143:166-190.
24. Hurford WE, Kolker AC, Strauss HW. The use of ventilation/perfusion lung scans to predict oxygenation during one-lung anesthesia. Anesthesiology. 1987;67(5):841–4.
25. Marshall C, Marshall B: Site and sensitivity for stimulation of hypoxic pulmonary vasoconstriction. J Appl Physiol 1983;55:711–6.
26. Hambraeus-Jonzon K, Bindslev L, Mellgård AJ, Hedenstierna G: Hypoxic pulmonary vasoconstriction in human lungs. A stimulus-response study. Anesthesiology 1997;86:308–15.
27. Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg. 2008;135(2):247-54.
28. Steier J, Lunt A, Hart N, Polkey MI, Moxham J. Observational study of the effect of obesity on lung volumes. Thorax. 2014;69(8):752–912.
29. Guenoun T, Journois D, Silleran-Chassany J, Frappier J, D’attellis N, Salem A, Safran D: Prediction of arterial oxygen tension during one-lung ventilation: Analysis of preoperative and intraoperative variables. J Cardiothorac Vasc Anesth 2002;16:199–203.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright of their work and grant the Macedonian Journal of Anaesthesia the right of first publication.
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Authors are permitted to enter into separate, additional contractual arrangements for the non-exclusive distribution of the published version of the work, provided that its initial publication in this journal is acknowledged.
