الفهرس 
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Abstract
Lung resection surgery using one lung ventilation can affect oxygenation causing hypoxemia and carry high risk of acute lung injury with postoperative pulmonary complications.
Lung protective ventilation and lung recruitment maneuvers are advocated in order to lessen the degree of acute lung injury and to reduce postoperative pulmonary complications(76). Although lung-protective ventilation can decrease acute lung injury, but may lead to collapse of the alveoli due to application of low tidal volume, so lung recruitment maneuver is considered the best method for improving oxygenation, reducing ventilation-perfusion mismatch and reverting atelectasis during one lung ventilation(77).
The primary aim of the present study was to study the effect of stepwise lung recruitment maneuver in patients undergoing lung resection surgery on oxygenation parameters, while the secondary aim was to evaluate the effect of recruitment on lung mechanics, lung injury biomarker represented by tumor necrosis factor alpha (TNF-⍺), pulmonary functions, haemodynamic parameters, and postoperative pulmonary complications.
This prospective controlled randomized single blinded study was carried out in Alexandria university hospitals and Kafrelsheikh university hospitals on 40 adult patients belonging to American Society of Anaesthesiologists (ASA) physical status class II – III with age ranged from 20-60 years scheduled for elective lung resection surgeries using one lung ventilation under general anaesthesia, after approval of the ethical committee of Faculty of Medicine, Alexandria University and having an informed written consent from every patient included in the study.
Patients were randomly allocated into 2 equal groups (20 patients in each group) using closed envelope technique.
• group (C) control group: Conventional mechanical ventilation was performed.
• group (LR) lung recruitment group: This group was subjected to stepwise lung recruitment maneuver, in which it was applied twice, the first (LR1): was performed after start of (OLV) to the dependent lung, while the second (LR2): was performed after resuming (TLV).