Role of continuous positive airway pressure to the non-ventilated lung during one-lung ventilation with low tidal volumes

INTRODUCTION: In multiple study populations large tidal volumes (8 - 12 ml/kg) have deleterious effects on lung function in multiple study populations. The accepted approach to hypoxemia during one-lung ventilation is the application of continuous positive airway pressure to the non-ventilated lung first, followed by application of positive end-expiratory pressure to the ventilated lung. To our knowledge the effectiveness of positive end-expiratory pressure or continuous positive airway pressure on maintaining PaO(2) with one-lung ventilation was not studied with smaller tidal volume (6ml/kg) ventilation. Our objective was to compare continuous positive airway pressure of 5 cm H(2)O or positive end-expiratory pressure of 5 cm H(2)O during small tidal volume one-lung ventilation. METHODS: Thirty patients undergoing elective, open thoracotomy with one-lung ventilation were randomized to continuous positive airway pressure or positive end-expiratory pressure and then crossed over to the other modality. RESULTS: There was a statistically significant higher PaO(2) (141±81.6 vs 112±48.7, p = 0.047) with continuous positive airway pressure than positive end-expiratory pressure while on one-lung ventilation. Two patients desaturated requiring 100% O(2) with both positive end-expiratory pressure and continuous positive airway pressure. On two occasions the surgeon requested the continuous positive airway pressure be discontinued due to lung inflation. CONCLUSION: The use of continuous positive airway pressure of 5 cm H(2)O to the non-ventilated lung while using small tidal volumes for one-lung ventilation improved PaO(2) when compared with positive end-expiratory pressure of 5 cm H(2)O to the ventilated lung.