The Effects of Iloprost on Oxygenation During One-Lung Ventilation for Lung Surgery: A Randomized Controlled Trial

Overview

Journal J Clin Med

Specialty General Medicine

Date 2019 Jul 10

PMID 31284472

Citations 9

Authors

Hoon Choi

Joonpyo Jeon

Jaewon Huh

Jungmin Koo

Sungwon Yang

Wonjung Hwang

Affiliations

Soon will be listed here.

Abstract

Hypoxemia can occur during one-lung ventilation (OLV) in thoracic surgery, leading to perioperative complications. Inhaled iloprost is a selective pulmonary vasodilator with efficacy in patients with pulmonary hypertension. The purpose of this study was to evaluate the effects of off-label inhaled iloprost on oxygenation during OLV in patients undergoing lung surgery. Seventy-two patients who were scheduled for elective video-assisted thoracoscopic lobectomy were assigned to receive an inhaled nebulizer of distilled water (control group), 10 μg iloprost (IL10 group), or 20 μg iloprost (IL20 group). Arterial and venous blood gas and hemodynamic analyses were obtained. Changes in partial pressure of oxygen in arterial blood (PaO), after the initiation of OLV and the resumption two-lung ventilation (TLV), were similar in all three groups. However, PaO in the IL10 group was comparable to that in the control group, whereas PaO in the IL20 group was significantly higher than that in the control group at 10, 20, and 30 min after administration of iloprost (275.1 ± 50.8 vs. 179.3 ± 38.9, < 0.0001; 233.9 ± 39.7 vs. 155.1 ± 26.5, < 0.0001; and 224.6 ± 36.4 vs. 144.0 ± 22.9, < 0.0001, respectively). The shunt fraction in the IL20 group was significantly higher than that in the control group after administration of iloprost (26.8 ± 3.1 vs. 32.2 ± 3.4, < 0.0001; 24.6 ± 2.2 vs. 29.9 ± 3.4, < 0.0001; and 25.3 ± 2.0 vs. 30.8 ± 3.1, < 0.0001, respectively). Administration of inhaled iloprost during OLV improves oxygenation and decreases intrapulmonary shunt.

Citing Articles

Continuous positive airway pressure combined with small-tidal-volume ventilation on arterial oxygenation and pulmonary shunt during one-lung ventilation in patients undergoing video-assisted thoracoscopic lobectomy: A randomized, controlled study.

Yang Y, Jia D, Cheng L, Jia K, Wang J Ann Thorac Med. 2024; 19(2):155-164.

PMID: 38766377 PMC: 11100470. DOI: 10.4103/atm.atm_240_23.

Effect of Deferasirox on Shunt Fraction During Thoracic Surgery With One-Lung Ventilation: A Randomized Controlled Study.

Raman R, Nair P, Siddiqui A, Prabha R, Kohli M, Srivastava V Cureus. 2023; 15(5):e39071.

PMID: 37323343 PMC: 10267769. DOI: 10.7759/cureus.39071.

Effects of Iloprost on Arterial Oxygenation and Lung Mechanics during One-Lung Ventilation in Supine-Positioned Patients: A Randomized Controlled Study.

Lee K, Kim M, Kim N, Kang S, Oh Y J Pers Med. 2022; 12(7).

PMID: 35887551 PMC: 9323331. DOI: 10.3390/jpm12071054.

Effects of Iloprost on Oxygenation during One-Lung Ventilation in Patients with Low Diffusing Capacity for Carbon Monoxide: A Randomized Controlled Study.

Lee K, Oh Y, Kim M, Song S, Kim N J Clin Med. 2022; 11(6).

PMID: 35329869 PMC: 8949409. DOI: 10.3390/jcm11061542.

A randomised controlled trial on roles of prostaglandin E1 nebulization among patients undergoing one lung ventilation.

Li P, Gu L, Tan J, Song Z, Bian Q, Jiao D BMC Pulm Med. 2022; 22(1):37.

PMID: 35027012 PMC: 8759228. DOI: 10.1186/s12890-022-01831-4.

References

Garutti I, Quintana B, Olmedilla L, Cruz A, Barranco M, Garcia de Lucas E . Arterial oxygenation during one-lung ventilation: combined versus general anesthesia. Anesth Analg. 1999; 88(3):494-9. DOI: 10.1097/00000539-199903000-00005. View

Sittipunt C, Steinberg K, Ruzinski J, Myles C, Zhu S, GOODMAN R . Nitric oxide and nitrotyrosine in the lungs of patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2001; 163(2):503-10. DOI: 10.1164/ajrccm.163.2.2004187. View

Schwarzkopf K, Klein U, Schreiber T, Preussetaler N, Bloos F, Helfritsch H . Oxygenation during one-lung ventilation: the effects of inhaled nitric oxide and increasing levels of inspired fraction of oxygen. Anesth Analg. 2001; 92(4):842-7. DOI: 10.1097/00000539-200104000-00009. View

Gessler T, Schmehl T, Hoeper M, Rose F, Ghofrani H, Olschewski H . Ultrasonic versus jet nebulization of iloprost in severe pulmonary hypertension. Eur Respir J. 2001; 17(1):14-9. DOI: 10.1183/09031936.01.17100140. View

Rocca G, Passariello M, Coccia C, Costa M, Di Marco P, Venuta F . Inhaled nitric oxide administration during one-lung ventilation in patients undergoing thoracic surgery. J Cardiothorac Vasc Anesth. 2001; 15(2):218-23. DOI: 10.1053/jcan.2001.21972. View

Turnaoglu S, Tugrul M, Camci E, Cakar N, Akinci O, Ergin P . Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth. 2001; 15(5):574-9. DOI: 10.1053/jcan.2001.26534. View

Wet C, Affleck D, Jacobsohn E, Avidan M, Tymkew H, Hill L . Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery. J Thorac Cardiovasc Surg. 2004; 127(4):1058-67. DOI: 10.1016/j.jtcvs.2003.11.035. View

Pruszkowski O, Dalibon N, Moutafis M, Jugan E, Law-Koune J, Laloe P . Effects of propofol vs sevoflurane on arterial oxygenation during one-lung ventilation. Br J Anaesth. 2007; 98(4):539-44. DOI: 10.1093/bja/aem039. View

Ozcan P, Senturk M, Sungur Ulke Z, Toker A, Dilege S, Ozden E . Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one-lung ventilation. Acta Anaesthesiol Scand. 2007; 51(8):1117-22. DOI: 10.1111/j.1399-6576.2007.01374.x. View

10.

Naseem K, Riba R . Unresolved roles of platelet nitric oxide synthase. J Thromb Haemost. 2007; 6(1):10-9. DOI: 10.1111/j.1538-7836.2007.02802.x. View

11.

Harris K, ORiordan T, Smaldone G . Aerosolized iloprost customized for the critically ill. Respir Care. 2007; 52(11):1507-9. View

12.

Karzai W, Schwarzkopf K . Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology. 2009; 110(6):1402-11. DOI: 10.1097/ALN.0b013e31819fb15d. View

13.

Rimeika D, Sanchez-Crespo A, Nyren S, Lindahl S, Wiklund C . Iloprost inhalation redistributes pulmonary perfusion and decreases arterial oxygenation in healthy volunteers. Acta Anaesthesiol Scand. 2009; 53(9):1158-66. DOI: 10.1111/j.1399-6576.2009.02018.x. View

14.

Dernaika T, Beavin M, Kinasewitz G . Iloprost improves gas exchange and exercise tolerance in patients with pulmonary hypertension and chronic obstructive pulmonary disease. Respiration. 2009; 79(5):377-82. DOI: 10.1159/000242498. View

15.

Raghunathan K, Connelly N, Robbins L, Ganim R, Hochheiser G, DiCampli R . Inhaled epoprostenol during one-lung ventilation. Ann Thorac Surg. 2010; 89(3):981-3. DOI: 10.1016/j.athoracsur.2009.07.059. View

16.

Xu Y, Tan Z, Wang S, Shao H, Zhu X . Effect of thoracic epidural anesthesia with different concentrations of ropivacaine on arterial oxygenation during one-lung ventilation. Anesthesiology. 2010; 112(5):1146-54. DOI: 10.1097/ALN.0b013e3181d40347. View

17.

Ng A, Swanevelder J . Hypoxaemia associated with one-lung anaesthesia: new discoveries in ventilation and perfusion. Br J Anaesth. 2011; 106(6):761-3. DOI: 10.1093/bja/aer113. View

18.

Boeck L, Tamm M, Grendelmeier P, Stolz D . Acute effects of aerosolized iloprost in COPD related pulmonary hypertension - a randomized controlled crossover trial. PLoS One. 2013; 7(12):e52248. PMC: 3531427. DOI: 10.1371/journal.pone.0052248. View

19.

Sawheny E, Ellis A, Kinasewitz G . Iloprost improves gas exchange in patients with pulmonary hypertension and ARDS. Chest. 2013; 144(1):55-62. DOI: 10.1378/chest.12-2296. View

20.

Lumb A, Slinger P . Hypoxic pulmonary vasoconstriction: physiology and anesthetic implications. Anesthesiology. 2015; 122(4):932-46. DOI: 10.1097/ALN.0000000000000569. View