Review
New evidence in one-lung ventilation
Nueva evidencia en ventilación unipulmonar
Read
3
Timeswas read the article
0
Total PDF
3
Total HTML
Share statistics
array:24 [ "pii" => "S2341192918300106" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.009" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "843" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:149-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0034935617301652" "issn" => "00349356" "doi" => "10.1016/j.redar.2017.06.007" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "843" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "ssu" "cita" => "Rev Esp Anestesiol Reanim. 2018;65:149-53" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 662 "formatos" => array:2 [ "HTML" => 438 "PDF" => 224 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Revisión</span>" "titulo" => "Nueva evidencia en ventilación unipulmonar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "153" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "New evidence in one-lung ventilation" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "H. Meleiro, I. Correia, P. Charco Mora" "autores" => array:3 [ 0 => array:2 [ "nombre" => "H." "apellidos" => "Meleiro" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Correia" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Charco Mora" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341192918300106" "doi" => "10.1016/j.redare.2018.01.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300106?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301652?idApp=UINPBA00004N" "url" => "/00349356/0000006500000003/v2_201803170457/S0034935617301652/v2_201803170457/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341192918300052" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.004" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "841" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:154-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>" "titulo" => "Isolated limb perfusion with cytostatic drug leakage" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "154" "paginaFinal" => "159" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Perfusión aislada de extremidad inferior con fuga de quimioterapéutico" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1558 "Ancho" => 1447 "Tamanyo" => 342928 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Monitoring of possible leakage into systemic circulation using portable gamma camera (top). The graph (below) shows the gradual increase in the radiotracer activity in the systemic circulation that indicates cytostatic leakage from the right lower extremity (slope).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Zarazua, P. Paredes, F. Gahete-Santiago, R. Rull, A. Blasi, J. Balust" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Zarazua" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Paredes" ] 2 => array:2 [ "nombre" => "F." "apellidos" => "Gahete-Santiago" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Rull" ] 4 => array:2 [ "nombre" => "A." "apellidos" => "Blasi" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Balust" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617301639" "doi" => "10.1016/j.redar.2017.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617301639?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300052?idApp=UINPBA00004N" "url" => "/23411929/0000006500000003/v3_201803240409/S2341192918300052/v3_201803240409/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341192918300040" "issn" => "23411929" "doi" => "10.1016/j.redare.2018.01.003" "estado" => "S300" "fechaPublicacion" => "2018-03-01" "aid" => "879" "copyright" => "Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Revista Española de Anestesiología y Reanimación (English Version). 2018;65:143-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Prognosis and predictors of mortality in critically ill elderly patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "143" "paginaFinal" => "148" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pronóstico y predictores de mortalidad de los pacientes ancianos críticos" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Suarez-de-la-Rica, C. Castro-Arias, J. Latorre, F. Gilsanz, E. Maseda" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Suarez-de-la-Rica" ] 1 => array:2 [ "nombre" => "C." "apellidos" => "Castro-Arias" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Latorre" ] 3 => array:2 [ "nombre" => "F." "apellidos" => "Gilsanz" ] 4 => array:2 [ "nombre" => "E." "apellidos" => "Maseda" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0034935617302463" "doi" => "10.1016/j.redar.2017.11.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0034935617302463?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300040?idApp=UINPBA00004N" "url" => "/23411929/0000006500000003/v3_201803240409/S2341192918300040/v3_201803240409/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review</span>" "titulo" => "New evidence in one-lung ventilation" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "153" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "H. Meleiro, I. Correia, P. Charco Mora" "autores" => array:3 [ 0 => array:4 [ "nombre" => "H." "apellidos" => "Meleiro" "email" => array:1 [ 0 => "hlmeleiro@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Correia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "P." "apellidos" => "Charco Mora" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Serviço de Anestesiologia, Centro Hospitalar de São João, Porto, Portugal" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Hospital Clínico Universitario de Valencia, Valencia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nueva evidencia en ventilación unipulmonar" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anesthesia in thoracic surgery has some particularities. The need for lung collapse and one-lung ventilation (OLV), and the lateral decubitus position complicate ventilatory management in patient with associated respiratory disease.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Both OLV and lateral decubitus call for modifications in ventilation and pulmonary perfusion. In the dependent lung compliance decreases and airway resistance increases. Furthermore, the collapsed lung will increase intrapulmonary shunt, contributing to hypoxemia. Hypoxic pulmonary vasoconstriction (HPV) is a physiological autoregulation mechanism against hypoxia by which blood flow in unventilated pulmonary areas is actively reduced and derived to well-ventilated areas and reducing ventilation perfusion mismatch (V/Q).</p><p id="par0015" class="elsevierStylePara elsevierViewall">Mechanical ventilation in thoracic surgery has undergone significant changes in recent years due to the implementation of lung protective ventilation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Lung protective ventilation refers to the use of low tidal volume (TV) (8–6<span class="elsevierStyleHsp" style=""></span>mL/kg of predicted body weight), lower plateau pressure (≤30<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O), moderate PEEP (≥5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O according to inspired fraction of O<span class="elsevierStyleInf">2</span> to an arterial oxygen tension (PaO<span class="elsevierStyleInf">2</span>) between 55 and 80<span class="elsevierStyleHsp" style=""></span>mmHg), with or without the use of recruitment maneuvers. These different strategies can all reduce mechanical stresses on the lung, which are thought to cause ventilator-induced lung injury, and its benefits in patients with acute respiratory distress syndrome (ARDS) are well established.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">1–4</span></a> Lung protective ventilation is also used in ICU patients with normal lungs and in patients undergoing abdominal surgery under general anesthesia, who are at high risk for pulmonary complications.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The beneficial effects of lung protective ventilation remain questionable in OLV. This review will analyze recent ventilatory strategies in OLV.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">A MEDLINE search of randomized clinical trials, metanalysis, reviews and systematic reviews published in the last 5 years using the Mesh term “One-Lung Ventilation” was performed on 21 March 2017. A total of 75 articles were initially found. The author reviewed the title and abstract of each article and selected those dealing with lung protective ventilation or acute lung injury in one-lung ventilation. Fourteen articles were included after the title and abstract review.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Thoracic surgery and lung injury</span><p id="par0035" class="elsevierStylePara elsevierViewall">Acute lung injury after thoracic surgery is multifactorial. A multiple-hit sequence of deleterious events interacts to injure the alveolar epithelium and the capillary endothelium.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">A combination of direct surgical trauma and mechanical ventilation may contribute to postoperative lung injury. Mechanical ventilation can be damaging to the lung, mainly for two reasons. Firstly, the use of high pressures and high tidal volume (TV) cause alveolar overdistension. Secondly, repeated opening and closing of alveoli causes atelectrauma. These two mechanisms will determine the local and systemic release of cytokines and other mediators of inflammation, leading to biotrauma, which contributes to the process of lung injury caused by mechanic ventilation.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Lung protective ventilation: tidal volume (TV)</span><p id="par0045" class="elsevierStylePara elsevierViewall">The ideal tidal volume (TV) to maintain adequate oxygenation during OLV remains controversial. Textbooks and reviews recommend using high TV (≥10<span class="elsevierStyleHsp" style=""></span>mL/kg) without positive end-expiratory pressure (PEEP) to prevent atelectasis.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Numerous authors have reported that high TV during OLV might increase the incidence of acute lung injury due to large peak inspiratory pressures, end-inspiratory volumes, and shearing forces due to cyclic opening-closing of the alveoli.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There is growing evidence that low TV (<8<span class="elsevierStyleHsp" style=""></span>mL/kg predicted body weight) during OLV could prevent lung injury. Nevertheless, low TV has been associated with worsening intraoperative atelectasis and intrapulmonary shunt, contributing to hypoxia and hypercapnia. However, low TV combined with additional positive end-expiratory pressure (PEEP) can reduce the incidence of atelectasis by preventing lung collapse.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">A study comparing the effects of low TV (5<span class="elsevierStyleHsp" style=""></span>mL/kg and 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O PEEP) and high TV (10<span class="elsevierStyleHsp" style=""></span>mL/kg and no PEEP) during OLV showed that arterial oxygenation and shunt fraction were similar with TV of 5<span class="elsevierStyleHsp" style=""></span>mL/kg and 10<span class="elsevierStyleHsp" style=""></span>mL/kg in patients undergoing open chest surgery with normal lung function.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">6</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In 100 patients undergoing OLV for scheduled lobectomy, conventional OLV (FiO<span class="elsevierStyleInf">2</span> 1.0, TV 10<span class="elsevierStyleHsp" style=""></span>mL/kg, no PEEP, and volume-controlled ventilation) was compared to the lung protective strategy (FiO<span class="elsevierStyleInf">2</span> 0.5, TV 6<span class="elsevierStyleHsp" style=""></span>mL/kg, PEEP 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O, and pressure-controlled ventilation). The latter showed higher postoperative PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> ratio and fewer immediate pulmonary complications in the first postoperative 72<span class="elsevierStyleHsp" style=""></span>h, while providing adequate oxygenation and ventilation during OLV.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">7</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">A computed tomographic (CT) study in a porcine OLV model with a TV of 10<span class="elsevierStyleHsp" style=""></span>ml/kg is associated with expanded normally aerated lung regions at end-inspiration but not at end-expiration. TV 10<span class="elsevierStyleHsp" style=""></span>ml/kg results in a higher ratio of normally aerated lung regions and increases PaO<span class="elsevierStyleInf">2</span>. These changes are less significant during OLV with a TV of 5<span class="elsevierStyleHsp" style=""></span>ml/kg. However, improved oxygenation through higher TV results in uneven distribution of aeration and increased mechanical stress. There is an increase in the cyclic transitional area, which suggests alveolar collapse and reopening.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">According to these reports, a combination of low TV (5–6<span class="elsevierStyleHsp" style=""></span>mL/kg) and moderate PEEP (5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O) could provide adequate oxygenation and ventilation during OLV, promote lung aeration, avoid mechanical stress, and possibly reduce lung injury during perioperative period.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Lung protective ventilation: positive end-expiratory pressure (PEEP)</span><p id="par0080" class="elsevierStylePara elsevierViewall">Application of PEEP during OLV as part of a protective ventilation regime has been shown to prevent atelectasis and decrease lung injury markers. However, the effect of PEEP on oxygenation during OLV is variable. Moderate levels of PEEP (5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O) applied during thoracic surgery in healthy patients is well tolerated, but does not improve oxygenation in all cases.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A recent study compared OLV with individualized PEEP (after a PEEP decrement trial) to standard PEEP of 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O in thoracic surgery. The results showed that during OLV the effects of an alveolar recruitment maneuver (ARM) on lung function were better preserved with an individualized level of PEEP based on a PEEP decrement trial compared with that of PEEP levels of 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O. Arterial oxygenation was significantly higher with the individualized PEEP.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Lung protective ventilation: alveolar recruitment maneuvers</span><p id="par0090" class="elsevierStylePara elsevierViewall">Atelectasis occurs in dependent lung areas of most patients under anesthesia.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5,8</span></a> Atelectasis formation during OLV worsens the already high shunt fraction, increasing the potential for hypoxemia.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">5,8</span></a> The risk factors that predispose lung derecruitment during OLV include high FiO<span class="elsevierStyleInf">2</span>, low tidal volume, the lack of PEEP, and extrinsic compression by abdominal contents, the heart, or the mediastinum.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">The effects of ARM on pulmonary gas/tissue distribution during OLV in porcine models were examined by CT. ARM in the whole lung before OLV provides sustained effects that extend to OLV: lung volume and aeration was increased, respiratory compliance was enhanced, and areas of cyclic recruitment/derecruitment were reduced. These effects were independent of TV during OLV.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">8</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">In other two clinical trials, ARM immediately prior to OLV improved arterial oxygenation.<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">10,11</span></a> This recruitment-induced improvement in lung physiology was sustained throughout the entire surgical procedure. These effects were attributed to increasing ventilation efficiency by decreasing the alveolar component of dead space.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a> Control groups without recruitment showed increased alveolar dead space values throughout the study.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">10</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">According to these reports, ARM might improve arterial oxygenation and lung mechanics by decreasing dead space and improving lung compliance.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Inspiration:expiration ratio</span><p id="par0110" class="elsevierStylePara elsevierViewall">Prolonged inspiratory time is known to be effective for increasing oxygenation and reducing peak airway pressure in adults with respiratory distress syndrome.</p><p id="par0115" class="elsevierStylePara elsevierViewall">The benefits of this have been studied in OLV.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">12,13</span></a> In patients with normal lung function undergoing lobectomy, oxygenation was modestly better with an inspiration:expiration (I:E) ratio of 1:1<span class="elsevierStyleHsp" style=""></span>at 60<span class="elsevierStyleHsp" style=""></span>minutes of OLV when compared to a ratio of 1:2. The 1:1 ratio reduced peak inspiratory, plateau pressures and dead space and improved compliance.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">12</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">When a 1:1 ratio during OLV was applied to patients with low diffusing capacity of the lung for carbon monoxide (DLCO<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>80%) undergoing thoracoscopic lobectomy, it did not substancially improve oxygenation, although it did improved lung mechanics by reducing peak pressure and improving dynamic compliance, and increasing the efficiency of alveolar ventilation with no significant hemodynamic changes.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">13</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Hypercapnic ventilation</span><p id="par0125" class="elsevierStylePara elsevierViewall">Permissive hypercapnic is a lung protective strategy used in patients with ARDS in order to maintain low alveolar pressure and minimize the complications of alveolar overdistension during low TV ventilation. The resulting hypercapnia and respiratory acidosis may have a protective effect against ventilator-associated lung injury, thus reducing mortality.<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">14</span></a> Hypercapnia is usually well tolerated if arterial carbon dioxide tension (PaCO<span class="elsevierStyleInf">2</span>) increases slowly. Acute hypercapnia is more likely to lead to cardiovascular dysfunction and neurologic dysfunction; furthermore hypercapnia is contraindicated in patients with intracranial hypertension.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">15</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">In OLV, hypercapnic ventilation maintains steady pulmonary oxygenation.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">16,17</span></a> Hypercapnia has hemodynamic effects during OLV by decreasing systemic vascular resistance index<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">16</span></a> and also increasing the need of inotropic support.<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">17</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">A recent clinical trial evaluated hypercapnic ventilation in patients undergoing lobectomy. Patients were randomized to receive OLV (TV 6<span class="elsevierStyleHsp" style=""></span>ml/kg PEEP 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O) with a mixture of oxygen and air (air group, pCO<span class="elsevierStyleInf">2</span> 35–45<span class="elsevierStyleHsp" style=""></span>mmHg) or a combination of oxygen, air and carbon dioxide (carbon dioxide group, pCO<span class="elsevierStyleInf">2</span> 60–70<span class="elsevierStyleHsp" style=""></span>mmHg). Hypercapnia improved respiratory function after OLV in lobectomy patients, reduced peak and plateau pressures and increased dynamic compliance. Hypercapnia also inhibited local and systematic inflammation by reducing serum and bronchoalveolar lavage fluid inflammatory mediators.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">18</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Continuous positive airway pressure (CPAP)</span><p id="par0140" class="elsevierStylePara elsevierViewall">The application of CPAP in collapsed lung improves gas exchange, alveolar recruitment, and lung capacity. In the surgical setting, CPAP can also be applied on the collapsed lung during one-lung ventilation for thoracic surgery. This could potentially reduce intraoperative hypoxia in the collapsed lung and mechanical stress by keeping the alveoli open. It has traditionally been used for lung ventilation in the treatment of intraoperative hypoxemia.</p><p id="par0145" class="elsevierStylePara elsevierViewall">A recent study found that the application of a CPAP of 5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O in collapsed lung during thoracoscopic esophagectomy reduced local concentration of inflammatory mediators when compared to the non-CPAP collapsed lung group. The CPAP group also presented lower concentrations of local inflammatory mediators in the ventilated lung. However, there was no noticeable effect of CPAP on the incidence of postoperative pneumonia. The authors suggest that CPAP could obstruct visibility during the surgical procedure.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">19</span></a></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Type of anesthesia during OLV</span><p id="par0150" class="elsevierStylePara elsevierViewall">During one-lung ventilation, both inhalatory and intravenous anesthesia can be used. The method chosen to maintain anesthesia may affect patient outcomes. Older-generation volatile anesthetics inhibited hypoxic pulmonary vasoconstriction (HPV) in a dose-dependent fashion. However, latest volatile anesthetics (isoflurane, sevoflurane, and desflurane) are only weak inhibitors of HPV compared to those used previously (halothane, enflurane).<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">20</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">A result of recent Cochrane review of 20 studies with a total of 850 subjects comparing intravenous (e.g. propofol) versus inhalation (e.g. isoflurane, sevoflurane, desflurane) anesthesia for OLV in surgical participants were inconclusive. There is insufficient evidence that the choice of anesthesia (inhalational versus intravenous) affects oxygenation during OLV or the incidence of lung injury.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">21</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">In another study,<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">22</span></a> arterial oxygenation and intrapulmonary shunt during OLV were evaluated using different anesthesia maintenance protocols. One group received isoflurane combined with intravenous infusion of dexmedetomidine (DEX) (0.7<span class="elsevierStyleHsp" style=""></span>μg/kg/min) and another received isoflurane combined with saline infusion. DEX infusion along with isoflurane inhalation can significantly reduce arterial oxygen pressure drop and ventilation perfusion mismatch (V/Q) during first-40<span class="elsevierStyleHsp" style=""></span>min of OLV. Nevertheless, these findings could be transient/limited to intraoperative OLV, since respiratory postoperative outcomes were not evaluated.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Non-dependent lung ventilation (NDL)</span><p id="par0165" class="elsevierStylePara elsevierViewall">Intermittent positive pressure ventilation of the non-dependent lung (NDL) could be an effective strategy to manage hypoxemia during OLV in thoracotomy. In a recent prospective study,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">23</span></a> non-depend lung (NDL) ventilation with small volumes was started if the patients desaturated to <95% during OLV using a separate ventilator, with FiO<span class="elsevierStyleInf">2</span> of 1.0, TV of 70<span class="elsevierStyleHsp" style=""></span>ml, I:E ratio of 1:10 and respiratory rate of 6/min for 15<span class="elsevierStyleHsp" style=""></span>min. This ventilator strategy increased mean PaO<span class="elsevierStyleInf">2</span> from 91.2<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>31.7<span class="elsevierStyleHsp" style=""></span>mmHg on OLV to 145.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>50.2<span class="elsevierStyleHsp" style=""></span>mmHg (after 5<span class="elsevierStyleHsp" style=""></span>min of NDL) and 170.6<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>50.4<span class="elsevierStyleHsp" style=""></span>mmHg (after 15<span class="elsevierStyleHsp" style=""></span>min of NDL). This ventilatory strategy was not evaluated in thoracoscopic surgery.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">Lung ventilation should aim to use lung protective ventilation to minimize lung trauma by avoiding overdistension and repetitive alveolar collapse, thereby limiting plateau pressure while providing adequate oxygenation. Lung protective ventilation is not simply synonymous with low tidal volume ventilation (4–6<span class="elsevierStyleHsp" style=""></span>ml/kg predicted body weight), but also includes strategies to maintain open lung ventilation, namely routine use of moderate PEEP (≥5<span class="elsevierStyleHsp" style=""></span>cmH<span class="elsevierStyleInf">2</span>O) and lung recruitment preceding OLV and repeated as necessary. New techniques are widely discusses, namely, PEEP adjustment, inspiration:expiration ratio, ideal type of anesthesia during OLV, small tidal volume ventilation of non-dependent lung, and hypercapnic ventilation. Current research into anti-inflammatory agents and driving pressure in OLV holds promise for future interventions.</p><p id="par0175" class="elsevierStylePara elsevierViewall">There are no published guidelines on ventilatory strategy during lung surgery. Anesthesiologists should tailor perioperative management to the patient's needs and the surgical procedure in order to limit the damage caused by surgical and ventilatory aggression.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Ethical disclosures</span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Protection of human and animal subjects</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Confidentiality of data</span><p id="par0190" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Right to privacy and informed consent</span><p id="par0195" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interests</span><p id="par0200" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interests.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Authors’ contribution</span><p id="par0180" class="elsevierStylePara elsevierViewall">All listed authors contributed to the study. All authors listed in this review have directly participated in the planning, execution, or analysis of this study; all listed authors have read and approved the final version of the manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:20 [ 0 => array:3 [ "identificador" => "xres1008337" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec968012" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1008338" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec968013" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Thoracic surgery and lung injury" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Lung protective ventilation: tidal volume (TV)" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Lung protective ventilation: positive end-expiratory pressure (PEEP)" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Lung protective ventilation: alveolar recruitment maneuvers" ] 10 => array:2 [ "identificador" => "sec0035" "titulo" => "Inspiration:expiration ratio" ] 11 => array:2 [ "identificador" => "sec0040" "titulo" => "Hypercapnic ventilation" ] 12 => array:2 [ "identificador" => "sec0045" "titulo" => "Continuous positive airway pressure (CPAP)" ] 13 => array:2 [ "identificador" => "sec0050" "titulo" => "Type of anesthesia during OLV" ] 14 => array:2 [ "identificador" => "sec0055" "titulo" => "Non-dependent lung ventilation (NDL)" ] 15 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusion" ] 16 => array:3 [ "identificador" => "sec0070" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0075" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0080" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0085" "titulo" => "Right to privacy and informed consent" ] ] ] 17 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interests" ] 18 => array:2 [ "identificador" => "sec0065" "titulo" => "Authors’ contribution" ] 19 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-04-05" "fechaAceptado" => "2017-06-29" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec968012" "palabras" => array:3 [ 0 => "One-lung ventilation" 1 => "Protective lung ventilation" 2 => "Thoracic anesthesia" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec968013" "palabras" => array:3 [ 0 => "Ventilación unipulmonar" 1 => "Ventilación pulmonar protectora" 2 => "Anestesia torácica" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Mechanical ventilation in thoracic surgery has undergone significant changes in recent years due to the implementation of the protective ventilation. This review will analyze recent ventilatory strategies in one-lung ventilation.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A MEDLINE research was performed using Mesh term “One-Lung Ventilation” including randomized clinical trials, metanalysis, reviews and systematic reviews published in the last 6 years. Search was performed on 21st March 2017. A total of 75 articles were initially found. After title and abstract review 14 articles were included.</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Protective ventilation is not simply synonymous of low tidal volume ventilation, but it also includes routine use of PEEP and alveolar recruitment maneuver. New techniques are still in discussion namely PEEP adjustment, ratio inspiration:expiration, ideal type of anesthesia during one-lung ventilation and hypercapnic ventilation.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ventilación mecánica en cirugía torácica ha sufrido cambios significativos en los últimos años debido a la implantación de la ventilación protectora. Esta revisión analizará las estrategias ventilatorias recientes en la ventilación unipulmonar.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se realizó una búsqueda en MEDLINE utilizando el término MeSH «One-Lung Ventilation», incluyendo ensayos clínicos aleatorios, metaanálisis, revisiones y revisiones sistemáticas publicadas en los últimos 6 años. La búsqueda se realizó el 21 de marzo de 2017. Inicialmente se encontraron un total de 75 artículos. Después de la revisión del título y resumen se incluyeron 14 artículos.</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">La ventilación protectora no es simplemente sinónimo de ventilación de bajo volumen tidal, sino que también incluye el uso rutinario de PEEP y la maniobra de reclutamiento alveolar. Las nuevas técnicas siguen discutiéndose, a saber: ajuste de PEEP, ratio inspiración:espiración, tipo ideal de anestesia durante ventilación unipulmonar y ventilación hipercápnica.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Meleiro H, Correia I, Charco Mora P. Nueva evidencia en ventilación unipulmonar. Rev Esp Anestesiol Reanim. 2018;65:149–153.</p>" ] 1 => array:2 [ "etiqueta" => "☆ ☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">This article is part of the Anaesthesiology and Resuscitation Continuing Medical Education Program. An evaluation of the questions on this article can be made through the Internet by accessing the Education Section of the following web page: <a class="elsevierStyleInterRef" target="_blank" id="intr1005" href="http://www.elsevier.es/redar">www.elsevier.es/redar</a></p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:23 [ 0 => array:3 [ "identificador" => "bib0120" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.B. Amato" 1 => "C.S. Barbas" 2 => "D.M. Medeiros" 3 => "R.B. Magaldi" 4 => "G.P. Schettino" 5 => "G. Lorenzi-Filho" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM199802053380602" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "1998" "volumen" => "338" "paginaInicial" => "347" "paginaFinal" => "354" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9449727" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0125" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Acute Respiratory Distress Syndrome Network" "etal" => false "autores" => array:6 [ 0 => "R.G. Brower" 1 => "M.A. Matthay" 2 => "A. Morris" 3 => "D. Schoenfeld" 4 => "B.T. Thompson" 5 => "A. Wheeler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJM200005043421801" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2000" "volumen" => "342" "paginaInicial" => "1301" "paginaFinal" => "1308" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10793162" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0130" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Driving pressure and survival in the acute respiratory distress syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.B. Amato" 1 => "M.O. Meade" 2 => "A.S. Slutsky" 3 => "L. Brochard" 4 => "E.L.V. Costa" 5 => "D.A. Schoenfeld" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMsa1410639" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2015" "volumen" => "372" "paginaInicial" => "747" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25693014" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0135" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilator-induced lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A.S. Slutsky" 1 => "V.M. Ranieri" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra1208707" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2013" "volumen" => "369" "paginaInicial" => "2126" "paginaFinal" => "2136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24283226" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0140" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute lung injury in thoracic surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G.D. Rocca" 1 => "C. Coccia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Curr Opin Anesthesiol" "fecha" => "2013" "volumen" => "26" "paginaInicial" => "40" "paginaFinal" => "45" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0145" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of different tidal volumes for one-lung ventilation on oxygenation with open chest condition and surgical manipulation: a randomised cross-over trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Végh" 1 => "M. Juhhász" 2 => "S. Szatmári" 3 => "A. Enyed" 4 => "D.I. Sessler" 5 => "L.L. Szegedi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2013" "volumen" => "79" "paginaInicial" => "24" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23135690" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0150" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery? A randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Yang" 1 => "H.J. Ahn" 2 => "K. Kim" 3 => "J.A. Kim" 4 => "C.A. Yi" 5 => "M.J. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.09-2293" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2011" "volumen" => "139" "paginaInicial" => "530" "paginaFinal" => "537" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20829341" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0155" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ventilatory protective strategies during thoracic surgery effects of alveolar recruitment maneuver and low-tidal volume ventilation on lung density distribution" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Kozian" 1 => "T. Schilling" 2 => "H. Schutze" 3 => "M. Senturk" 4 => "T. Hachenberg" 5 => "G. Hedenstierna" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0b013e318216469f" "Revista" => array:7 [ "tituloSerie" => "Anesthesiology" "fecha" => "2011" "volumen" => "114" "paginaInicial" => "1009" "paginaFinal" => "1010" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21521963" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204514700671" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0160" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Setting individualized positive end-expiratory pressure level with a positive end expiratory pressure decrement trial after a recruitment maneuver improves oxygenation and lung mechanics during one-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Ferrando" 1 => "A. Mugarra" 2 => "A. Gutierrez" 3 => "J.A. Carbonell" 4 => "M. García" 5 => "M. Soro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1213/ANE.0000000000000105" "Revista" => array:6 [ "tituloSerie" => "Anesth Analg" "fecha" => "2014" "volumen" => "118" "paginaInicial" => "657" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24557111" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0165" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Unzeta" 1 => "G. Tusman" 2 => "F. Suarez-Sipmann" 3 => "S. Bohm" 4 => "V. Moral" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aer415" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2012" "volumen" => "108" "paginaInicial" => "517" "paginaFinal" => "524" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22201185" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0170" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A preemptive alveolar recruitment strategy before one-lung ventilation improves arterial oxygenation in patients undergoing thoracic surgery: a prospective randomised study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.H. Park" 1 => "Y.T. Jeon" 2 => "J.W. Hwang" 3 => "S.H. Do" 4 => "J.H. Kim" 5 => "H.P. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Eur J Anaesthesiol" "fecha" => "2011" "volumen" => "28" "paginaInicial" => "298" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21513078" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673604174473" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0175" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effects of prolonged inspiratory time during one-lung ventilation: a randomised controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.M. Lee" 1 => "W.H. Kim" 2 => "H.J. Ahn" 3 => "J.A. Kim" 4 => "M.K. Yang" 5 => "C.H. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Anesthesia" "fecha" => "2013" "volumen" => "68" "paginaInicial" => "908" "paginaFinal" => "916" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0180" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypercapnic acidosis and mortality in acute lung injury" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D.A. Kregenow" 1 => "G.D. Rubenfeld" 2 => "L.D. Hudson" 3 => "E.R. Swenson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Crit Care Med" "fecha" => "2006" "volumen" => "34" "paginaInicial" => "1" "paginaFinal" => "7" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16374149" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0185" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hypercapnia: permissive and therapeutic" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.P. Kavanagh" 1 => "J.G. Laffey" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Minerva Anestesiol" "fecha" => "2006" "volumen" => "72" "paginaInicial" => "567" "paginaFinal" => "576" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16682931" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0190" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Controlled hypercapnia during one-lung ventilation in patients undergoing pulmonary resection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J. Sticher" 1 => "M. Müller" 2 => "S. Scholz" 3 => "E. Schindler" 4 => "G. Hempelmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "2001" "volumen" => "45" "paginaInicial" => "842" "paginaFinal" => "847" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11472285" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0195" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Permissive hypercapnia during thoracic anaesthesia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H. Morisaki" 1 => "R. Serita" 2 => "Y. Innami" 3 => "Y. Kotake" 4 => "J. Takeda" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Anaesthesiol Scand" "fecha" => "1999" "volumen" => "43" "paginaInicial" => "845" "paginaFinal" => "889" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10492414" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0200" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effects of a 1:1 inspiratory to expiratory ratio on respiratory mechanics and oxygenation during one-lung ventilation in patients with low diffusion capacity of lung for carbon monoxide: a crossover study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Lee" 1 => "Y.J. Oh" 2 => "Y.S. Choi" 3 => "S.H. Kim" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jclinane.2015.06.012" "Revista" => array:6 [ "tituloSerie" => "J Clin Anesth" "fecha" => "2015" "volumen" => "27" "paginaInicial" => "445" "paginaFinal" => "450" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26263797" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0205" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of therapeutic hypercapnia on inflammatory responses to one-lung ventilation in lobectomy patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Gao" 1 => "D. Liu" 2 => "D. Li" 3 => "G. Cui" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/ALN.0000000000000627" "Revista" => array:7 [ "tituloSerie" => "Anesthesiology" "fecha" => "2015" "volumen" => "122" "paginaInicial" => "1235" "paginaFinal" => "1252" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25751232" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673613622990" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0210" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reduced local immune response with continuous positive airway pressure during one-lung ventilation for oesophagectomy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.J.J. Verhage" 1 => "J. Boone" 2 => "G.T. Rijkers" 3 => "G.J. Gromheecke" 4 => "A.C. Kroese" 5 => "T.J. Weijs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/bja/aet476" "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2014" "volumen" => "112" "paginaInicial" => "920" "paginaFinal" => "928" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24523436" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0215" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evidence-based management of one-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Lohser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.anclin.2008.01.011" "Revista" => array:6 [ "tituloSerie" => "Anesthesiol Clin" "fecha" => "2008" "volumen" => "26" "paginaInicial" => "241" "paginaFinal" => "272" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18456211" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0220" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intravenous versus inhalation anaesthesia for one-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.S.P. Módolo" 1 => "M.P. Módolo" 2 => "M.A. Marton" 3 => "E. Volpato" 4 => "V. Monteiro-Arantes" 5 => "P. do-Nascimento-Junior" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "volumen" => "11" "paginaInicial" => "CD006313" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0225" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of intravenous infusion of dexmedetomidine combined with inhalation of isoflurane on arterial oxygenation and intrapulmonary shunt during single-lung ventilation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Xia" 1 => "H. Yin" 2 => "Z.Y. Xia" 3 => "Q.J. Mao" 4 => "G.D. Chen" 5 => "W. Xu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s12013-013-9659-8" "Revista" => array:6 [ "tituloSerie" => "Cell Biochem Biophys" "fecha" => "2013" "volumen" => "67" "paginaInicial" => "1547" "paginaFinal" => "1550" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23733668" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0230" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effectiveness of ventilation of nondependent lung for a brief period in improving arterial oxygenation during one-lung ventilation: a prospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K. Chigurupati" 1 => "S.P. Raman" 2 => "U.K. Pappu" 3 => "U. Madathipat" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4103/0971-9784.197840" "Revista" => array:6 [ "tituloSerie" => "Ann Card Anaesth" "fecha" => "2017" "volumen" => "20" "paginaInicial" => "72" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28074800" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23411929/0000006500000003/v3_201803240409/S2341192918300106/v3_201803240409/en/main.assets" "Apartado" => null "PDF" => "https://static.elsevier.es/multimedia/23411929/0000006500000003/v3_201803240409/S2341192918300106/v3_201803240409/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341192918300106?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2021 November | 1 | 0 | 1 |
| 2020 December | 1 | 0 | 1 |
