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Improved Oxygenation During Thoracotomy with Selective PEEP to the Dependent Lung

DAVID R. BROWN, MD^*, ENID R. KAFER, MD, FRACP, FFARCS, VIRGIL O. ROBERSON, MD, BENSON R. WILCOX, MD, and GORDON F. MURRAY, MD^||

*Associate Professor, Department of Anesthesiology., University of North Carolina School of Medicine, Chapel, Hill, North Carolina 27514. Associate Professor, Departments of Anesthesiology and Physiology., University of North Carolina School of Medicine, Chapel, Hill, North Carolina 27514. Resident, Department of Anesthesiology., University of North Carolina School of Medicine, Chapel, Hill, North Carolina 27514. Professor and Division Chief, Department of Surgery, Division of Cardiothoracic Surgery., University of North Carolina School of Medicine, Chapel, Hill, North Carolina 27514. ||Associate Professor, Department of Surgery, Division of Cardiothoracic Surgery., University of North Carolina School of Medicine, Chapel, Hill, North Carolina 27514.

Abstract

In 22 patients during thoracotomy in the lateral position, the effects of selective positive end expiratory pressure (PEEP) to the dependent lung while simultaneously ventilating the non-dependent lung at zero end-expiratory pressure (ZEEP) on (1) inspired O₂ concentration required to maintain adequate Pao₂ during thoracotomy and (2) alveolar-arterial oxygen difference (Aao₂D) while breathing 100 percent O₂ at the end of thoracotomy were examined and compared to ventilation of both lungs at ZEEP. Selective PEEP to the dependent lung resulted in adequate Pao₂ with a lower inspired O₂ concentration (44 ± SD 6% versus 70 ± SD 21%), and a smaller Aao₂D while breathing 100 percent O₂ 189 ± SD 31 versus 342 ± SD 69 torr) at the end of thoracotomy.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999