Correspondence  |   April 2007
Association of High Tidal Volume with Postpneumonectomy Failure
Author Affiliations & Notes
  • Evans R. Fernández Pérez, M.D.
  • *Mayo Clinic College of Medicine, Rochester, Minnesota.
Article Information
Correspondence   |   April 2007
Association of High Tidal Volume with Postpneumonectomy Failure
Anesthesiology 4 2007, Vol.106, 876. doi:10.1097/01.anes.0000264783.69113.ff
Anesthesiology 4 2007, Vol.106, 876. doi:10.1097/01.anes.0000264783.69113.ff
In Reply:—
We thank Dr. Neustein for his comments and appreciate the opportunity to reply.
We agree with Dr. Neustein that the absence of reliable data on airway pressures and tidal volumes during one-lung ventilation is a major limitation of our study. Indeed, we are currently undertaking a prospective cohort study in patients at high risk for postoperative pulmonary complications such as those undergoing lung resection to evaluate the cumulative exposure to potentially harmful intraoperative ventilator settings. This study includes a precise calculation of exposure during one-lung ventilation.
Our study design did not allow us to determine the mechanism of the observed interaction between the intraoperative tidal volume and fluid administration.1 
A definitive trial to prove that intraoperative mechanical ventilation per se  causes acute lung injury in humans would be difficult to design. Short-term large tidal volume mechanical ventilation during anesthesia has been associated with worsening pulmonary inflammatory response in experimental animal models.2,3 Despite some controversies, corresponding human data support the hypothesis that even brief exposure to high-tidal-volume ventilation influences the inflammatory and coagulation response in the lung.4–6 In our study, postoperative respiratory failure in the group of patients receiving larger tidal volume was observed during surgery as short as 244 min (25% interquartile range). Although optimal ventilator settings in patients undergoing pneumonectomy are yet to be determined, we believe that to maximize patient safety, routine use of very large tidal volumes (> 10 ml/kg predicted body weight) during two- and in particular during one-lung ventilation is potentially harmful and should be avoided.7–9 
*Mayo Clinic College of Medicine, Rochester, Minnesota.
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