The impact of different inspired oxygen concentrations combined with nebulized prostaglandin E1 on oxygenation in patients undergoing one-lung ventilation: a randomized controlled trial

Abstract

Abstract Background One-lung ventilation (OLV) requires a high inspired oxygen concentration (FiO2) to promote oxygenation improvement, yet it increases the risk of postoperative pulmonary complications. Therefore, this study aimed to investigate the effects of prostaglandin E1 (PGE1) in reducing FiO2 during general anesthesia and mechanical ventilation on oxygenation and postoperative complications in patients undergoing OLV. Method A total of 120 patients scheduled for elective left thoracotomy esophageal cancer surgery were randomly divided into four groups (n = 30): Group L (FiO2 = 0.4, PGE1 = 0.1 µg /kg), Group M (FiO2 = 0.5, PGE1 = 0.1 µg /kg), Group H (FiO2 = 0.6, PGE1 = 0.1 µg /kg), and Group C (FiO2 = 0.4, normal saline solution). The primary outcome was oxygenation during OLV. Secondary outcomes included intrapulmonary shunt (Qs/Qt), incidence of postoperative pulmonary complications, and changes in inflammatory cytokines. Results Group H exhibited higher PaO2 values than Groups L, M, and C at all time points T1-T6. Group M also showed higher PaO2 values than Groups L and C at all time points T1-T6. In contrast, Group L demonstrated significantly higher PaO2 values than Group C at time points T2-T4. The nebulization groups (L, M, H) had significantly higher PaO2/FiO2 than Group C at time points T2-T4. Group H had higher Qs/Qt values than Groups L, M, and C at all time points T1-T6. At time points T2-T4, Group L had significantly lower Qs/Qt values compared to both Group C and Group M, which in turn had significantly lower values than Group C. Regarding interleukin-6 (IL-6) levels, Group C was significantly higher than the nebulization groups at time points T5-T8, while Group L was significantly lower than Groups M and H at T8. In terms of tumor necrosis factor-α(TNF-α) levels, Group C was significantly higher than the nebulization groups at time points T7-T8. With respect to clinical pulmonary infection score (CPIS), Group L was significantly lower than Groups M, H, and C. There was no statistically significant difference in the overall incidence of postoperative complications probability (PPCs) among the four groups, nor were there statistically significant differences in pneumothorax, pulmonary infection, anastomotic leakage, ICU stay duration, or total hospital stay duration among the groups. Conclusion PGE1 demonstrates a significant advantage in reducing the incidence of hypoxemia, effectively improving oxygenation status in patients undergoing OLV with lower FiO2. Given the effects of PGE1 on oxygenation and inflammatory factors, as well as the CPIS, the results of this study suggest that a clinical regimen of 0.4 FiO2 + 0.1 µg /kg PGE1 is appropriate. Trial registration Chictr.org.cn identifier: Retrospectively registered, ChiCTR1800018288(09/09/2018).

Keywords

• Prostaglandin E1
• One-lung ventilation
• Inspired oxygen concentration