Physiological effects of two driving pressure-based methods to set positive end-expiratory pressure during one lung vent
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ORIGINAL RESEARCH
Physiological effects of two driving pressure‑based methods to set positive end‑expiratory pressure during one lung ventilation Savino Spadaro1 · Salvatore Grasso2 · Dan Stieper Karbing3 · Giuseppe Santoro1 · Giorgio Cavallesco4 · Pio Maniscalco4 · Francesca Murgolo2 · Rosa Di Mussi2 · Riccardo Ragazzi1 · Stephen Edward Rees3 · Carlo Alberto Volta1 · Alberto Fogagnolo1 Received: 27 May 2020 / Accepted: 17 August 2020 © Springer Nature B.V. 2020
Abstract During one-lung ventilation (OLV), titrating the positive end-expiratory pressure (PEEP) to target a low driving pressure (∆P) could reduce postoperative pulmonary complications. However, it is unclear how to conduct PEEP titration: by stepwise increase starting from zero PEEP ( PEEPINCREMENTAL) or by stepwise decrease after a lung recruiting manoeuvre (PEEPDECREMENTAL). In this randomized trial, we compared the physiological effects of these two PEEP titration strategies on respiratory mechanics, ventilation/perfusion mismatch and gas exchange. Patients undergoing video-assisted thoracoscopic surgery in OLV were randomly assigned to a PEEPINCREMENTAL or PEEPDECREMENTAL strategy to match the lowest ∆P. In the PEEPINCREMENTAL group, PEEP was stepwise titrated from ZEEP up to 16 cm H 2O, whereas in the P EEPDECREMENTAL group PEEP was decrementally titrated, starting from 16 cm H2O, immediately after a lung recruiting manoeuvre. Respiratory mechanics, ventilation/perfusion mismatch and blood gas analyses were recorded at baseline, after PEEP titration and at the end of surgery. Sixty patients were included in the study. After PEEP titration, shunt decreased similarly in both groups, from 50 [39–55]% to 35 [28–42]% in the PEEPINCREMENTAL and from 45 [37–58]% to 33 [25–45]% in the PEEPDECREMENTAL group (both p
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