Background: Protective ventilation strategy has been shown to reduce ventilator-induced
lung injury in ARDS patients. In this study, we questioned whether protective ventilatory
settings would attenuate lung impairment during one lung ventilation (OLV) compared to
conventional ventilation in patients undergoing lung resection surgery.
Methods: One hundred ASA 1-2 patients scheduled for an elective lobectomy were
enrolled in the study. During OLV, two different ventilation strategies were compared. The
conventional strategy (CV group, n=50) consisted of FiO2 1.0, VT 10 ml/kg, ZEEP, and
volume-controlled ventilation, while the protective strategy (PV group, n=50) consisted of
FiO2 0.5, VT 6 ml/kg, PEEP 5 cm H2O, and pressure-controlled ventilation. The composite
primary endpoint included, PaO2/FiO2 < 300 mmHg and/or the presence of newly developed lung lesions (lung infiltration and atelectasis) within 72 hours of the operation. To monitor safety during OLV, SpO2, PaCO2, and PIP were repeatedly measured. Results: During OLV, although 58% of the PV group needed elevated FiO2 to maintain an SpO2 above 95%, PIP was significantly lower than in the CV group whereas the mean PaCO2 values remained at 35-40 mmHg in both groups. Importantly, in the PV group, the incidence of the primary endpoint of pulmonary dysfunction was significantly lower than in the CV group (the incidence of PaO2/FiO2 < 300 mmHg, lung infiltration, or atelectasis : 4% vs. 22%, P < 0.05). Conclusion: Compared with the traditional large VT and volume-controlled ventilation, the application of small VT and PEEP through pressure-controlled ventilation was associated with a lower incidence of postoperative lung dysfunction and satisfactory gas exchange.