Intermittent reinflation is safe to maintain oxygenation without alteration of extravascular lung water during one-lung ventilation

Study ObjectiveTo investigate whether a maneuver for repeated cycles of collapse and reexpansion of the operative lung, termed “intermittent reinflation” (IR), to counter hypoxemia during one-lung ventilation (OLV), results in a time-dependent alteration of extravascular lung water.DesignProspective, randomized clinical study.SettingOperating room and postsurgical intensive care unit of a university hospital.Patients36 ASA physical status 1 and 2 patients undergoing elective, video-assisted thoracic surgery for lung tumors.InterventionsPatients were randomly assigned to two groups. Group C consisted of 18 patients whose nondependent lung was kept collapsed during OLV, while Group IR included 18 patients with IR that consisted of 4 separate, 10-second manual inflations and 5-second openings within one minute at intervals of 20 minutes during OLV.MeasurementsPerioperative parameters included transcutaneous oxygen saturation (SpO2), hemodynamic data, extravascular lung water index (EVLWI), pulmonary vascular permeability index (PVPI) as determined by the single-indicator transpulmonary thermodilution technique, and partial pressure of arterial oxygen/inspired oxygen fraction (PaO2/FIO2) ratio.Main ResultsGroup IR had significantly higher SpO2 at 20 minutes after commencement of OLV (98.9% vs 96.3%, P = 0.029) and average SpO2 throughout OLV (98.7% vs 97.0%, P = 0.020). Hemodynamic data, EVLWI, PVPI, and PaO2/FIO2 ratio did not differ between the groups, and there were no differences between groups in postoperative morbidity or hospital stay.ConclusionsIntermittent reinflation had a beneficial effect on oxygenation during OLV, without any significant effects on EVLW or postoperative outcomes.