A Randomised Controlled Trial on Roles of Prostaglandin E1 Nebulization Among Patients Undergoing One Lung Ventilation

Overview

Journal BMC Pulm Med

Publisher Biomed Central

Specialty Pulmonary Medicine

Date 2022 Jan 14

PMID 35027012

Authors

Pengyi Li

Lianbing Gu

Jing Tan

Zhenghuan Song

Qingming Bian

Dian Jiao

Zeping Xu

Lijun Wang

Affiliations

Soon will be listed here.

Abstract

Background: Prostaglandin E1 (PGE1) has been reported to maintain adequate oxygenation among patients under 60% FiO one-lung ventilation (OLV). This research aimed to explore whether PGE1 is safe in pulmonary shunt and oxygenation under 40% FiO OLV and provide a reference concentration of PGE1.

Methods: Totally 90 esophageal cancer patients treated with thoracotomy were enrolled in this study, randomly divided into three groups (n = 30/group): Group A (60% FiO and 0.1 µg/kg PGE1), Group B (40% FiO and 0.1 µg/kg PGE1), and Group C (40% FiO, 0.2 µg/kg PGE1). Primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included oxidative stress after OLV.

Results: During OLV, patients in Group C and B had lower levels of PaO, SaO, SpO, MAP, and Qs/Qt than those in Group A (P < 0.05). At T2 (OLV 10 min), patients in Group C and B exhibited a lower level of PaO/FiO than those in Group A, without any statistical difference at other time points. The IL-6 levels of patients in different groups were different at T8 (F = 3.431, P = 0.038), with IL-6 in Group C being lower than that in Group B and A. MDA levels among the three groups differed at T5 (F = 4.692, P = 0.012) and T7 (F = 5.906, P = 0.004), with the MDA level of Group C being lower than that of Group B and A at T5, and the MDA level of Group C and B being lower than that of Group A at T7. In terms of TNF-α level, patients in Group C had a lower level than those in Group B and A at T8 (F = 3.598, P = 0.033). Compared with patients who did not use PGE1, patients in Group C had comparable complications and lung infection scores.

Conclusion: The concentration of FiO could be reduced from 60 to 40% to maintain oxygenation. 40% FiO + 0.2 µg/kg PGE1 is recommended as a better combination on account of its effects on the inflammatory factors.

Trial Registration: Chictr.org.cn identifier: ChiCTR1800018288, 09/09/2018.

References

Campos J, Feider A . Hypoxia During One-Lung Ventilation-A Review and Update. J Cardiothorac Vasc Anesth. 2018; 32(5):2330-2338. DOI: 10.1053/j.jvca.2017.12.026. View

Walley K . Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med. 2010; 184(5):514-20. DOI: 10.1164/rccm.201010-1584CI. View

McGuire S . World Cancer Report 2014. Geneva, Switzerland: World Health Organization, International Agency for Research on Cancer, WHO Press, 2015. Adv Nutr. 2016; 7(2):418-9. PMC: 4785485. DOI: 10.3945/an.116.012211. View

Gezginci-Oktayoglu S, Orhan N, Bolkent S . Prostaglandin-E1 has a protective effect on renal ischemia/reperfusion-induced oxidative stress and inflammation mediated gastric damage in rats. Int Immunopharmacol. 2016; 36:142-150. DOI: 10.1016/j.intimp.2016.04.021. View

Tang M, Pan H, Zheng Z, Guo Y, Peng J, Yang J . Prostaglandin E1 protects cardiomyocytes against hypoxia-reperfusion induced injury via the miR-21-5p/FASLG axis. Biosci Rep. 2019; 39(12). PMC: 6923339. DOI: 10.1042/BSR20190597. View

Chen T, Lee Y, Wang M, Lee J, Lee Y, Chu S . Endothelin-1 concentrations and optimisation of arterial oxygenation and venous admixture by selective pulmonary artery infusion of prostaglandin E1 during thoracotomy. Anaesthesia. 1996; 51(5):422-6. DOI: 10.1111/j.1365-2044.1996.tb07783.x. View

Adatia I, Haworth S, Wegner M, Barst R, Ivy D, Stenmark K . Clinical trials in neonates and children: Report of the pulmonary hypertension academic research consortium pediatric advisory committee. Pulm Circ. 2013; 3(1):252-66. PMC: 3641736. DOI: 10.4103/2045-8932.109931. View

Afshari A, Bastholm Bille A, Allingstrup M . Aerosolized prostacyclins for acute respiratory distress syndrome (ARDS). Cochrane Database Syst Rev. 2017; 7:CD007733. PMC: 6483148. DOI: 10.1002/14651858.CD007733.pub3. View

Tekinbas C, Ulusoy H, Yulug E, Erol M, Alver A, Yenilmez E . One-lung ventilation: for how long?. J Thorac Cardiovasc Surg. 2007; 134(2):405-10. DOI: 10.1016/j.jtcvs.2007.05.003. View

10.

Li P, Gu L, Bian Q, Tan J, Jiao D, Wu F . Effects of prostaglandin E nebulization of ventilated lung under 60%O one lung ventilation on patients' oxygenation and oxidative stress: a randomised controlled trial. Respir Res. 2020; 21(1):113. PMC: 7218546. DOI: 10.1186/s12931-020-01380-6. View

11.

Yao W, Yang M, Cheng Q, Shan S, Yang B, Han Q . Effect of Pressure-Controlled Ventilation-Volume Guaranteed on One-Lung Ventilation in Elderly Patients Undergoing Thoracotomy. Med Sci Monit. 2020; 26:e921417. PMC: 7058148. DOI: 10.12659/MSM.921417. View

12.

Xu X, Wang X, Ge W, Pan L, Zheng M . The pharmacokinetics of inhaled morphine delivered by an ultrasonic nebulizer in ventilated dogs. J Aerosol Med Pulm Drug Deliv. 2011; 25(1):41-6. DOI: 10.1089/jamp.2010.0858. View

13.

Sood B, Keszler M, Garg M, Klein J, Ohls R, Ambalavanan N . Inhaled PGE1 in neonates with hypoxemic respiratory failure: two pilot feasibility randomized clinical trials. Trials. 2014; 15:486. PMC: 4414424. DOI: 10.1186/1745-6215-15-486. View

14.

Yang M, Ahn H, Kim K, Kim J, Yi C, Kim M . Does a protective ventilation strategy reduce the risk of pulmonary complications after lung cancer surgery?: a randomized controlled trial. Chest. 2010; 139(3):530-537. DOI: 10.1378/chest.09-2293. View

15.

Hardman J, Bedforth N, Ahmed A, Mahajan R, Aitkenhead A . A physiology simulator: validation of its respiratory components and its ability to predict the patient's response to changes in mechanical ventilation. Br J Anaesth. 1998; 81(3):327-32. DOI: 10.1093/bja/81.3.327. View

16.

Lytle F, Brown D . Appropriate ventilatory settings for thoracic surgery: intraoperative and postoperative. Semin Cardiothorac Vasc Anesth. 2008; 12(2):97-108. DOI: 10.1177/1089253208319869. View

17.

Grocott H, Wills G, Yamashita M . Dependent Lung Pulmonary Artery Hypoplasia as a Cause of Hypoxia during One-lung Ventilation. Anesthesiology. 2021; 134(5):770-771. DOI: 10.1097/ALN.0000000000003720. View

18.

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

19.

Liu K, Wang H, Yu S, Tu G, Luo Z . Inhaled pulmonary vasodilators: a narrative review. Ann Transl Med. 2021; 9(7):597. PMC: 8105872. DOI: 10.21037/atm-20-4895. View

20.

Purohit A, Bhargava S, Mangal V, Parashar V . Lung isolation, one-lung ventilation and hypoxaemia during lung isolation. Indian J Anaesth. 2015; 59(9):606-17. PMC: 4613408. DOI: 10.4103/0019-5049.165855. View