• C Unzueta, G Tusman, F Suarez-Sipmann, S Böhm, and V Moral.
• Department of Anesthesiology, Hospital de Sant Pau, Barcelona, Spain. mcunzueta@telefonica.net
• Br J Anaesth. 2012 Mar 1;108(3):517-24.

BackgroundThis study was conducted to determine whether an alveolar recruitment strategy (ARS) applied during two-lung ventilation (TLV) just before starting one-lung ventilation (OLV) improves ventilatory efficiency.MethodsSubjects were randomly allocated to two groups: (i) control group: ventilation with tidal volume (VT) of 8 or 6 ml kg(-1) for TLV and OLV, respectively, and (ii) ARS group: same ventilatory pattern with ARS consisting of 10 consecutive breaths at a plateau pressure of 40 and 20 cm H(2)O PEEP applied immediately before and after OLV. Volumetric capnography and arterial blood samples were recorded 5 min (baseline) and 20 min into TLV, at 20 and 40 min during OLV, and finally 10 min after re-establishing TLV.ResultsTwenty subjects were included in each group. In all subjects, the airway component of dead space remained constant during the study. Compared with baseline, the alveolar dead space ratio (VD(alv)/VT(alv)) increased throughout the protocol in the control but decreased in the ARS group. Differences in VD(alv)/VT(alv) between groups were significant (P<0.001). Except for baseline, all values in kPa (sd) were higher in the ARS than in the control group (P<0.001), respectively [70 (7) and 55 (9); 33 (9) and 24 (10); 33 (8) and 22 (10); 70 (7) and 55 (10)].ConclusionsRecruitment of both lungs before instituting OLV not only decreased alveolar dead space but also improved arterial oxygenation and the efficiency of ventilation.

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