Correspondence  |   December 2016
Complications of One-lung Ventilation: Is It the Blood Flow or the Ventilation?
Author Notes
  • Department of Anesthesiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania. rothj@einstein.edu
  • This letter was sent to the author of the original article referenced above, who declined to respond.— Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.
    This letter was sent to the author of the original article referenced above, who declined to respond.— Evan D. Kharasch, M.D., Ph.D., Editor-in-Chief.×
  • (Accepted for publication August 18, 2016.)
    (Accepted for publication August 18, 2016.)×
Article Information
Correspondence
Correspondence   |   December 2016
Complications of One-lung Ventilation: Is It the Blood Flow or the Ventilation?
Anesthesiology 12 2016, Vol.125, 1253-1254. doi:10.1097/ALN.0000000000001349
Anesthesiology 12 2016, Vol.125, 1253-1254. doi:10.1097/ALN.0000000000001349
The results of the study of management of one-lung ventilation by Blank et al.1  suggest that adequate positive end-expiratory pressure (PEEP) is an important factor in reducing pulmonary complications. Blank et al.1  provide an excellent discussion of the mechanical mechanisms and implications. I suggest an alternative or additional possible explanation of the beneficial effects of PEEP. The ventilated lung is subjected to increased blood flow, and this hyperemia may create additional shear stress, resulting in damage to the endothelial glycocalyx, which can then result in clinically significant respiratory complications.2–4  Studies support the concept that increased pulmonary blood flow may induce lung injury or aggravate a preexisting injury state.5–9  PEEP to the ventilated lung may reduce this hyperemia and hence reduce complications. Lower tidal volumes and the resultant reduced inspiratory pressure may result in more hyperemia, thus offsetting any potential beneficial effect of the expected reduced volutrauma. If we find a way to protect the glycocalyx or otherwise reduce the hyperemia to the ventilated lung, it is possible that lower tidal volumes may have a net beneficial effect. Larger tidal volumes to the ventilated lung may increase inspiratory pressure, resulting in less hyperemia and less damage to the glycocalyx, but damage from volutrauma could still occur.
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