Effect of Stepwise Lung Recruitment Maneuver on Oxygenation, Lung Mechanics and Lung Injury Biomarkers During Lung Resection Surgery: A Prospective Randomized Controlled Single Blinded Study

Sayed El Hefny, Dalia Ahmed El; Mohamed, Mohamed Ibrahim; Yousef El-Metainy, Shahira Ahmed; Ibrahim Abdelaal, Mohamed Moustafa; Osman, Yasser Mohamed

doi:TEJA-2021-0185

Effect of Stepwise Lung Recruitment Maneuver on Oxygenation, Lung Mechanics and Lung Injury Biomarkers During Lung Resection Surgery: A Prospective Randomized Controlled Single Blinded Study

Authors

TEJA-2021-0185

Abstract

Background
One lung ventilation for lung resection surgery may affect oxygenation, impair lung mechanics and increase the incidence of acute lung injury. Lung recruitment maneuver may improve these conditions.
Settings and Design
This study was a prospective randomized controlled single blinded clinical trial.
Methods
Forty patients scheduled for elective lung resection surgeries using one lung ventilation under general anaesthesia were randomly allocated into two groups. Control (C) group was subjected to conventional mechanical ventilation of tidal volume of 8 ml/kg and 5 ml/kg for total lung ventilation (TLV) and one lung ventilation (OLV), respectively, and PEEP of 5 cmHO and (LR) group which was subjected to stepwise lung recruitment twice: The first lung recruitment (LR1) was performed after (OLV) to the dependent lung, while the second lung recruitment (LR2) was performed after resuming (TLV). Arterial blood gases, lung mechanics and serum tumor necrosis factor alpha were recorded at multiple time points during the study. The proposal and raw data were registered on PACTR as
Results
There was a significant decrease in PaO/FIO during OLV baseline in comparison to TLV baseline (P = < 0.001*) in both groups. While, in LR group, there was a significant increase in PaO/FIO and dynamic compliance during OLV-20 min after recruitment (P = <0.001*), during TLV-20 min after recruitment (P = < 0.001*) and during TLV-end (P = <0.001*). TNF-⍺ level was significantly higher in control group 1 h after surgery and 24 h postoperative.
Conclusion
Stepwise lung recruitment maneuver improved oxygenation parameters and lung mechanics during lung resection surgery and decreased the expression of lung injury biomarkers.

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