Apneic oxygen insufflation decreases the incidence of hypoxemia during one-lung ventilation in open and thoracoscopic pulmonary lobectomy: A randomized controlled trial

Abstract

Objective: Hypoxemia is common during one-lung ventilation (OLV) for thoracic surgery. When hypoxemia occurs, surgery is interrupted for rescue ventilation. Apneic oxygen insufflation (AOI), which provides O₂ without applying pressure, may prevent hypoxemia and does not interrupt surgery. The aim of this study was to determine the effectiveness of the AOI technique for preventing hypoxemia during OLV in thoracic surgery.

Methods: Patients undergoing open or thoracoscopic pulmonary lobectomy from September to December 2015 were included. Patients were assigned randomly to a non-AOI group or an AOI group (n = 45 each). OLV was initiated and at the 15-minute mark (OLV15), patients in the AOI group received oxygen insufflation at 3 L/min to the nonventilated lung for 30 minutes (OLV45). The primary endpoint was the occurrence of hypoxemia (SaO₂ <90%) during OLV.

Results: The demographic and operative data were similar between the 2 groups. The incidence of hypoxemia was greater in the non-AOI than the AOI group (18% vs 0%; P = .009). ΔPaO₂ (the difference in partial pressure of oxygen in arterial blood between OLV 45 and 15 minutes) was smaller in the AOI than the non-AOI group (-29 mm Hg vs -69 mm Hg; P = .005). Duration of surgery and incidence of complications did not vary between groups.

Conclusions: AOI decreases the incidence of hypoxemia and improves arterial oxygenation during OLV for open and thoracoscopic surgery. AOI may be a valuable option to prevent hypoxemia. It can be used before relying on continuous positive airway pressure or intermittent two-lung ventilation and result in fewer interruptions in surgery.

Keywords: apneic oxygenation; hypoxemia; one-lung ventilation.