Lung protective strategies in anaesthesia

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Lung protective strategies in anaesthesia B Kilpatrick, P Slinger British Journal of Anaesthesia Volume 105, Pages i108-i116 (December 2010) DOI: 10.1093/bja/aeq299 Copyright © 2010 The Author(s) Terms and Conditions

Fig 1 (a) An inspiratory compliance curve (lung volume vs airway pressure) during OLV as the lung is slowly inflated by 100 ml increments in a patient with mild COPD. The lower inflection point of the curve (thought to represent FRC) is at 7 cm H2O. During OLV, this patient developed intrinsic PEEP (measured by the end-expiratory airway occlusion plateau pressure ‘auto-PEEP’) of 6 cm H2O. The addition of 5 cm H2O of PEEP in this patient raised the end-expiratory lung volume above FRC, thus raising pulmonary vascular resistance in the ventilated lung and caused a deterioration in oxygenation. (b) The inspiratory compliance curve during OLV in a patient with normal pulmonary function. The lower inflection point of the curve is at 6 cm H2O. During OLV, this patient developed intrinsic PEEP of 2 cm H2O. The addition of 5 cm H2O of PEEP raised the end-expiratory lung volume to FRC, thus decreasing pulmonary vascular resistance in the ventilated lung and caused an improvement in oxygenation. Based on data from Slinger and colleagues.37 British Journal of Anaesthesia 2010 105, i108-i116DOI: (10.1093/bja/aeq299) Copyright © 2010 The Author(s) Terms and Conditions

Fig 2 Impact of intraoperative lung protective strategies in lung cancer surgery. Comparison of historical control group vs lung protective ventilation group in patients undergoing OLV for lung cancer surgery showed significant benefits in terms of reduced ALI, atelectasis, and ICU admissions.42 British Journal of Anaesthesia 2010 105, i108-i116DOI: (10.1093/bja/aeq299) Copyright © 2010 The Author(s) Terms and Conditions