الفهرس 
One Lung VentilationOnly 14 pages are availabe for public view
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Abstract
Patients subjected to thoracic surgery are at increased risk of PPC. Among the adjustable risk factors for PPC, intraoperative ventilation techniques may imply hyperinflation of the lung. This is a major mechanism associated with VILI. This is mostly the case during OLV during thoracic surgery, when a large number of anesthesiologists do not reduce TV. That is unavoidably linked with elevated stress and strain. Thoracic surgery patients are at increased risk for complications. This could be due to underlying disease pathology, the type of surgery, reduced functional pulmonary tissue by resection, and the harmful effects of MV particularly during OLV. In spite of considerable progress in studying protective ventilation in TLV, greatly less data is available to monitor management of OLV to optimize proper management of ventilation during thoracic surgery. Consequently, the idea of lung-protective ventilation has arose. In addition, the significance of individual elements of lung-protective ventilation (low TV PEEP, and RM) needs further assessment. This study aimed to compare the effectiveness of using protective lung strategy with high PEEP and periodic RM vs. low PEEP without RM in decreasing the incidence of PPCs in patients undergoing thoracic surgery under OLV. This study was a prospective randomized controlled study that was conducted in United Kingdom, Royal Hallamshire Hospital, Sheffield Teaching Hospital, Harefield Hospital, London and Cardiothoracic Surgery Department at Tanta university Hospitals. The recruitment started from August 2019 to August 2022 after approval from the Tanta Faculty of Medicine ethical committee. Patients who met the inclusion criteria were enrolled in the study. The patients were randomly allocated into two equal groups by the use of a computer- generated numbers, the low and the high PEEP group. Demographic data (age, gender, weight) BMI, PBW were recorded in addition to the presence of diabetes, COPD grade and NYHA grade. Following intubation, in low PEEP group, PEEP was set at 5 cmH2O. Meanwhile, in the high PEEP group, PEEP was set at 10 cmH2O plus the RM. In the high PEEP group, RM was performed: During total lung ventilation, VT was set at 7 mL/kg PBW. During OLV, VT was 5 mL/kg PBW. Intraoperative monitoring included measurements of blood pressure, pulse oximetry, end-tidal carbon dioxide tension, temperature and electrocardiography. Patients who develop at least one PPC within 5 days was considered as meeting the 1ry endpoint. PPCs was defined as aspiration pneumonitis, moderate respiratory failure, severe respiratory failure, ARDS, pulmonary infection, atelectasis, cardiopulmonary edema, pleural effusion, pneumothorax, pulmonary infiltrates, prolonged air leakage, purulent pleuritic, pulmonary embolism and lung hemorrhage, The secondary outcome included extended PPC (including bronchospasm or mild respiratory failure, intraoperative complications, postoperative extrapulmonary complications, need for unexpected ICU, in-hospital survival and need for any postoperative respiratory intervention.