Is the use of PEEP during one lung ventilation safe in the patients with COPD undergoing thoracic surgery

Background and Goal of Study: Use of PEEP during OLV (one lung ventilation) in patients with chronic obstructive lung disease (COPD) is controversial. The BODE index is multidimensional grading system in COPD and it better defines the systemic effects of COPD on patients, than FEV₁ only. BODE index is formed as the sum of points assigned to each of the acronym BODE lettered variables and expresses a numerical range from 0 through 10. What is BODE index greater pulmonary function deteriorates. The goal of this study was to explore what is the impact of the application of the PEEP on OLV in patients with COPD in relation to their BODE index. Materials and methods: After obtaining approval of our Ethical Rewiev Bord and written informed consent, 137 patients ASA class II-III with a lung cancer and COPD in history scheduled for lobectomy.They were divided in six groups and given the BODE index. BODE Group 0 had the best lung function unlike BODE Group 5, which had the worst lung function. The patients were intubated with left Robertshow tube. After placing the patient in the lateral position, OLV was performed. During OLV, patients were ventilated pressure- controlled ventilation (PCV) with Vt 7 ml/kg, FiO₂ 0, 7. After that, in all patients PEEP was gradually increased every 15 minutes for 2 cmH₂O (0-8 cmH₂O). Data from arterial blood gases were taken 15 minutes after starting OLV, before PEEP and 15 minutes after PEEP 2, 4, 6, 8 cmH₂O. Results and discussion: In our patients BODE index was 0-5. BODE index 0 had 29 patients, BODE index 1 had 39 patients. The most patients had BODE index 2. BODE index 3 had 17 patients, only 3 patients had the largest measured BODE index 5. After gradually increased PEEP in our patients, there was no statistically significant effect on systolic, diastolic and mean arterial pressure. Optimal PEEP with which we have achieved the best oxygenation, ventilation and stability of circulation for groups BODE 0- 3 was 8 cmH₂O, for BODE 4 group was 6 cmH₂O. Only three patients, group BODE 5, had pptimally SaO₂ with PEEP 2 cmH₂O. Conclusion: Use of PEEP during OLV in patients with COPD undergoing lobectomy, whose BODE index is not greater than 5 is safe and provides optimal oxygenation and ventilation. Reference: 1. Hofman N, Canales C, Leduc M, Mahajan A. Positive end expiratory pressure during one- lung ventilation: selecting ideal patients and ventilator setting with the aim of improving arterial oxygenation. Ann Card Anaesth 2011 ; 14:183-7.