Effect of Recruitment Maneuvers Plus Optimal PEEP Versus Optimal PEEP Alone in One Lung Ventilation

Effect of Recruitment Maneuvers Plus Optimal PEEP Versus Optimal PEEP Alone on Ventilation Perfusion Mismatch and Respiratory Mechanics in One Lung Ventilation. A Randomized Trial

The intraoperative driving pressure (∆P) has been recently identified as the greater independent predictor of postoperative pulmonary complications after one lung ventilation (OLV). The application of a positive end-expiratory pressure (PEEP) level of 5 or 10 cmH2O has been shown to reduce the ∆P and the V/Q mismatch (Spadaro 2017); however, the "optimal" PEEP level able to minimize the ∆P may change significantly across patients. The aim of this study is to describe the optimal PEEP levels in patients undergoing thoracic surgery

Inclusion Criteria:

• Patients undergoing VATS with OLV ≥2 hours

Exclusion Criteria:

• ASA (American Society of Anesthesiologists Physical Status Classification) score ≥ 4
• severe chronic respiratory failure (chronic obstructive pulmonary disease patients with GOLD stage 3 or 4
• preoperative hemoglobin less than 10 g ml-1
• hemodynamic instability (defined as a decrease in systolic arterial pressure of more than 20% from baseline),