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Two-lung ventilation with artificial pneumothorax on cerebral desaturation and early postoperative cognitive outcome: a randomized controlled trial

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Abstract

Background

The effect of two lung ventilation (TLV) with carbon dioxide artificial pneumothorax on cerebral desaturation and postoperative neurocognitive changes in elderly patients undergoing elective minimally invasive esophagectomy (MIE) is unclear.

Objectives

The first aim of this study was to compare the effect of TLV and one lung ventilation (OLV) on cerebral desaturation. The second aim was to assess changes in early postoperative cognitive outcomes of two ventilation methods.

Methods

This prospective, randomized, controlled trial enrolled patients 65 and older scheduled for MIE. Patients were randomly assigned (1:1) to TLV group or OLV group. The primary outcome was the incidence of cerebral desaturation events (CDE). Secondary outcomes were the cumulative area under the curve of desaturation for decreases in regional cerebral oxygen saturation (rSO2) values below 20% relative to the baseline value (AUC.20) and the incidence of delayed neurocognitive recovery.

Results

Fifty-six patients were recruited between November 2019 and August 2020. TLV group had a lower incidence of CDE than OLV group [3 (10.71%) vs. 13 (48.14%), P = 0.002]. TLV group had a lower AUC.20 [0 (0–35.86) % min vs. 0 (0–0) % min, P = 0.007], and the incidence of delayed neurocognitive recovery [2 (7.4%) vs. 11 (40.7%), P = 0.009] than OLV group. Predictors of delayed neurocognitive recovery on postoperative day 7 were age (OR 1.676, 95% CI 1.122 to 2.505, P = 0.006) and AUC.20 (OR 1.059, 95% CI 1.025 to 1.094, P < 0.001).

Conclusion

Compared to OLV, TLV had a lower incidence of CDE and delayed neurocognitive recovery in elderly patients undergoing MIE. The method of TLV combined with carbon dioxide artificial pneumothorax may be an option for these elderly patients.

Chinese Clinical Trial Registry (identifier: ChiCTR1900027454).

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CBF:

Cerebral blood flow

CDE:

Cerebral oxygen desaturation events

CO2 :

Carbon dioxide

CPAP:

Continuous positive airway pressure

FiO2 :

The fraction of inspired oxygen

Hb:

Hemoglobin

HR:

Heart rate

MAP:

Mean arterial pressure

MIE:

Minimally invasive esophagectomy

MMSE:

Mini-Mental State Examination

NSE:

Neuron-specific enolase

OLV:

One lung ventilation

PaCO2 :

Partial pressure of arterial carbon dioxide

PaO2 :

Partial pressure of arterial oxygen

POCD:

Postoperative cognitive dysfunction

rSO2 :

Regional cerebral oxygen saturation

SpO2 :

Peripheral oxygen saturation

TLV:

Two lung ventilation

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Acknowledgements

We thank Dr. Xiaojie Pan and other partners from the Department of Thoracic Surgery of Fujian Provincial Hospital for their kind assistance with the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Lihua Lei and Yanlin Wu have equally contributed to this work.

Authors and Affiliations

  1. Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China

    Lihua Lei, Yanlin Wu, Min Chen, Qiaoping Liu & Wenshu Chen

  2. Department of Anesthesiology, Fujian Provincial Hospital, Fuzhou, 350001, Fujian, China

    Lihua Lei, Yanlin Wu, Min Chen & Qiaoping Liu

  3. Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, 37201, USA

    Wencong Chen

  4. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, 37201, USA

    Wencong Chen

  5. Department of Anesthesiology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, Fujian, China

    Qun Lin

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Contributions

Conception and design: LQ, LLH, and WYL; Administrative support: LQ; Provision of study materials or patients: CWS; Collection and assembly of data: CM and LQP; Data analysis and interpretation: WYL and CWC; Revise the manuscript: LQ and CWC; Manuscript writing: All authors; Final approval of manuscript: All authors.

Corresponding author

Correspondence to Qun Lin.

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Disclosures

Lihua Lei, Yanlin Wu, Wencong Chen, Min Chen, Qiaoping Liu, Wenshu Chen, Qun Lin, have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was reviewed by the Ethics Committee of Fujian Provincial Hospital, approval number: K2019-09-029, September 29th, 2019.

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Lei, L., Wu, Y., Chen, W. et al. Two-lung ventilation with artificial pneumothorax on cerebral desaturation and early postoperative cognitive outcome: a randomized controlled trial. Surg Endosc (2024). https://doi.org/10.1007/s00464-024-10786-y

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