Effects of prostaglandin E(1) nebulization of ventilated lung under 60%O(2) one lung ventilation on patients’ oxygenation and oxidative stress: a randomised controlled trial

BACKGROUND: High FiO(2) during one-lung ventilation (OLV) can improve oxygenation, but increase the risk of atelectasis and oxidative stress. The aim of this study was to analyze whether Prostaglandin E(1) (PGE(1)) can improve oxygenation and attenuate oxidative stress during OLV under a lower FiO(2). METHOD: Ninety patients selectively undergoing thoracotomy for esophageal cancer were randomly divided into three groups (n = 30/group): Group P (FiO(2) = 0.6, inhaling PGE(1) 0.1 μg/kg), Group L (FiO(2) = 0.6) and Group C (FiO(2) = 1.0). The primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included haemodynamics, respiratory mechanics and oxidative stress in serum. RESULTS: Patients in Group P had significantly higher PaO(2) and lower shunt fraction in 30 min of OLV compared with Group L. Compared with Group C, patients in Group P had similar levels of PaO(2)/FiO(2) in 60 min and higher levels of PaO(2)/FiO(2) at 2 h during OLV. The levels of PvO(2) and SvO(2) in Group P and Group L were significantly lower than Group C. Patients in Group P and Group L had significantly higher levels of superoxide dismutase and lower levels of malondialdehyde than Group C. No significant differences were found in SPO(2), ETCO(2), PaCO(2), Paw, HR and MAP among the three groups. The complications in Group C were significantly higher than another two groups. CONCLUSION: PGE(1) can maintain adequate oxygenation in patients with low FiO(2) (0.6) during OLV. Reducing FiO(2) to 0.6 during OLV can decrease the levels of oxidative stress and complications after OLV. TRIAL REGISTRATION: chictr.org.cn identifier: ChiCTR1800017100.