TY - JOUR

T1 - The Society for Translational Medicine

T2 - clinical practice guidelines for mechanical ventilation management for patients undergoing lobectomy

AU - Gao, Shugeng

AU - Zhang, Zhongheng

AU - Brunelli, Alessandro

AU - Chen, Chang

AU - Chen, Chun

AU - Chen, Gang

AU - Chen, Haiquan

AU - Chen, Jin-Shing

AU - Cassivi, Stephen

AU - Chai, Ying

AU - Downs, John B

AU - Fang, Wentao

AU - Fu, Xiangning

AU - Garutti, Martínez I

AU - He, Jianxing

AU - He, Jie

AU - Hu, Jian

AU - Huang, Yunchao

AU - Jiang, Gening

AU - Jiang, Hongjing

AU - Jiang, Zhongmin

AU - Li, Danqing

AU - Li, Gaofeng

AU - Li, Hui

AU - Li, Qiang

AU - Li, Xiaofei

AU - Li, Yin

AU - Li, Zhijun

AU - Liu, Chia-Chuan

AU - Liu, Deruo

AU - Liu, Lunxu

AU - Liu, Yongyi

AU - Ma, Haitao

AU - Mao, Weimin

AU - Mao, Yousheng

AU - Mou, Juwei

AU - Ng, Calvin Sze Hang

AU - Petersen, René H

AU - Qiao, Guibin

AU - Rocco, Gaetano

AU - Ruffini, Erico

AU - Tan, Lijie

AU - Tan, Qunyou

AU - Tong, Tang

AU - Wang, Haidong

AU - Wang, Qun

AU - Wang, Ruwen

AU - Wang, Shumin

AU - Xie, Deyao

AU - Zhang, Lanjun

AU - Zhao, Xuewei

AU - Zhi, Xiuyi

AU - et al.

AU - Zhou, Qinghua

PY - 2017/9

Y1 - 2017/9

N2 - Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.

AB - Patients undergoing lobectomy are at significantly increased risk of lung injury. One-lung ventilation is the most commonly used technique to maintain ventilation and oxygenation during the operation. It is a challenge to choose an appropriate mechanical ventilation strategy to minimize the lung injury and other adverse clinical outcomes. In order to understand the available evidence, a systematic review was conducted including the following topics: (I) protective ventilation (PV); (II) mode of mechanical ventilation [e.g., volume controlled (VCV) versus pressure controlled (PCV)]; (III) use of therapeutic hypercapnia; (IV) use of alveolar recruitment (open-lung) strategy; (V) pre-and post-operative application of positive end expiratory pressure (PEEP); (VI) Inspired Oxygen concentration; (VII) Non-intubated thoracoscopic lobectomy; and (VIII) adjuvant pharmacologic options. The recommendations of class II are non-intubated thoracoscopic lobectomy may be an alternative to conventional one-lung ventilation in selected patients. The recommendations of class IIa are: (I) Therapeutic hypercapnia to maintain a partial pressure of carbon dioxide at 50-70 mmHg is reasonable for patients undergoing pulmonary lobectomy with one-lung ventilation; (II) PV with a tidal volume of 6 mL/kg and PEEP of 5 cmH2O are reasonable methods, based on current evidence; (III) alveolar recruitment [open lung ventilation (OLV)] may be beneficial in patients undergoing lobectomy with one-lung ventilation; (IV) PCV is recommended over VCV for patients undergoing lung resection; (V) pre- and post-operative CPAP can improve short-term oxygenation in patients undergoing lobectomy with one-lung ventilation; (VI) controlled mechanical ventilation with I:E ratio of 1:1 is reasonable in patients undergoing one-lung ventilation; (VII) use of lowest inspired oxygen concentration to maintain satisfactory arterial oxygen saturation is reasonable based on physiologic principles; (VIII) Adjuvant drugs such as nebulized budesonide, intravenous sivelestat and ulinastatin are reasonable and can be used to attenuate inflammatory response.

U2 - 10.21037/jtd.2017.08.166

DO - 10.21037/jtd.2017.08.166

M3 - Review

C2 - 29221302

VL - 9

SP - 3246

EP - 3254

JO - Journal of Thoracic Disease

JF - Journal of Thoracic Disease

SN - 2072-1439

IS - 9

ER -