Fatma İBİŞ, Eser ŞAVKILIOĞLU, Fatma ULUS, Hilal Günal SAZAK, Ergül ULUÇINAR

Tek akciğer ventilasyonu sırasında CPAP ve PEEP uygulamalarının oksijenasyon ve şant fraksiyonu üzerine etkileri

Amaç: Tek akciğer ventilasyonu (TAV) sırasında bağımsız akciğere 4 cmH2O "continuous positive airway pressure" (CPAP) ve bağımlı akciğere 4 cmH2O "positive end-expiratory pressure" (PEEP) uygulamalarının oksijenasyon ve şant fraksiyonu üzerine etkilerinin araştırılmasıdır. Yöntem: Pulmoner rezeksiyon planlanan, ASA I-II grubundan 29 olgu çalışmaya alındı. Anestezi indüksiyonu 2 µg kg-1 fentanil, 2 mg kg-1 propofol, 0.1 mg kg-1 vekuronyum ile sağlandı. Sol çift lümenli tüp (ÇLT) ile entübasyon yapıldı. ‹damede %0.7-1.5 izofluran, fentanil ve vekuronyum kullanıldı. Ölçüm zamanları süresince %100 O2, sonrasında O2/N2O karışımı verildi. Tidal volüm 8-10 mL kg-1 ve solunum hızı ETCO2 30-35 mmHg olacak şekilde ayarlandı. Sağ internal juguler ven ve pulmoner arter kateteri yerleştirildi. Ölçümler çift akciğer ventilasyonu (ÇAV), TAV1, CPAP, TAV2, PEEP, TAV3 dönemlerinin 20. dakikalarında yapıldı. Kan basınçları, kalp atım hızı, SpO2, ortalama pulmoner arter basıncı ve PCWP kaydedildi. Arteriyel kan gazı ve miks venöz kan alınarak şant hesaplandı. Bulgular: ÇAV’dan TAV’a geçişte intrapulmoner şantta artış, PaO2’da azalma gözlendi. CPAP uygulaması ile şantın azaldığını, PaO2’nın arttığı, ancak PEEP uygulamasının intrapulmoner şant ve oksijenasyon üzerine etkisi olmadığı tespit edildi. Sonuç: TAV esnasında bağımsız akciğere 4 cmH2O CPAP uygulamasının, bağımlı akciğere 4 cmH2O PEEP uygulamasına göre oksijenasyonun korunması ve şantın azaltılması açısından daha yararlı bir yöntem olduğu kanısına varıldı.

The effects of CRAP and PEEP applications on oxygenation and shunt fraction during one-lung ventilation

Objective: We aimed to analyze the effects of 4 cmH2O of continuous positive airway pressure (CPAP) on the nondependent lung and 4 cmH2O of positive end-expiratory pressure (PEEP) on the dependent lung on oxygenation and shunt fraction during one-lung ventilation (OLV). Method: 29 cases in the ASA I-II group, who were scheduled to have elective pulmonary resection, were enrolled in this study. Anesthesia was induced with 2 µg kg-1 fentanyl, 2 mg kg-1 propofol and 0.1 mg kg-1 vecuronium. A left-sided double lumen tube was used for intubation. Maintenance of anaesthesia was provided by 0.7-1.5% isoflurane, fentanyl and vecuronium. Throughout the measurement periods 100% O2, then mixture of O2/N2O were given. Tidal volumes of 8-10 mL kg-1 were used with the rate adjusted to maintain ETCO2 between 30 and 35 mmHg. A central venous catheter and a pulmonary artery catheter were placed via the right internal jugular vein. Measurements were made at 20th minutes of two-lung ventilation, OLV1, CPAP, OLV2, PEEP and OLV3. At these times; blood pressures, heart rate, SpO2, mean pulmonary artery pressure and pulmonary capillary wedge pressure were recorded. Shunt calculation was achieved by arterial and mixed venous blood samples. Results: We observed an increase in intrapulmonary shunt and a decrease in PaO2 with the shift from two-lung ventilation to OLV. We determined that the shunt decreased and PaO2 increased with CPAP application, but PEEP application had no effect on intrapulmonary shunt and oxygenation. Conclusion: It has been considered that 4 cmH2O of CPAP application to nondependent lung is a more beneficial method than 4 cmH2O of PEEP application to dependent lung for maintaining oxygenation and decreasing the shunt.

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