Our Summary

This research paper examines the impact of a procedure called the “open lung approach” (OLA) on patients undergoing thoracic surgery in a position called “lateral decubitus”. During this type of surgery, only one lung is ventilated (one lung ventilation or OLV), which can cause some difficulties in breathing and gas exchange.

The OLA procedure involves initially fully inflating the lung, followed by gradually decreasing the positive pressure applied at the end of expiration (PEEP) until the best level of lung compliance (or flexibility) is achieved. The researchers were interested in seeing if this approach would improve the efficiency of gas exchange in the lungs and also wanted to study its effect on the mechanics of the respiratory system.

The study was conducted on thirteen patients undergoing a specific type of lung surgery (upper left lobectomy). The researchers measured various parameters related to lung and chest wall mechanics, as well as gas exchange and blood flow, before and after applying the OLA.

The results showed that after using the OLA, the ratio of oxygen in the arterial blood to the fraction of inspired oxygen improved, and lung compliance increased. There were no significant changes in chest wall compliance. The pressures driving the respiratory system and transpulmonary also decreased. Importantly, the OLA did not lead to any significant changes in blood flow.

In conclusion, the open lung approach improved oxygenation and increased lung compliance without any significant effects on blood flow. Although this study was not specifically designed to study the pressures driving the respiratory system and transpulmonary, a reduction in both was observed after the OLA.

FAQs

  1. What is the “open lung approach” (OLA) procedure in thoracic surgery?
  2. What were the main findings of the research regarding the impact of the OLA procedure on lung compliance and gas exchange?
  3. Did the open lung approach procedure have any significant effects on blood flow during the study?

Doctor’s Tip

Based on these findings, a doctor might tell a patient undergoing lung surgery the following helpful tip:

“After your surgery, we will be using a technique called the open lung approach to help improve your oxygen levels and lung function. This approach involves gradually adjusting the pressure in your lungs to optimize their flexibility and efficiency. Rest assured that this method has been shown to be beneficial and should help with your recovery.”

Suitable For

Patients who may benefit from lung surgery include those with:

  1. Lung cancer: Surgery may be recommended for the removal of tumors in the lungs.

  2. Chronic obstructive pulmonary disease (COPD): In severe cases where other treatments have not been effective, lung surgery may be considered to improve breathing.

  3. Emphysema: Surgery may be an option for patients with severe emphysema to remove damaged lung tissue.

  4. Lung infections: Surgery may be necessary for the removal of infected lung tissue in cases of chronic infections.

  5. Lung nodules: Surgery may be recommended to remove suspicious nodules in the lungs that could be cancerous.

  6. Lung trauma: In cases of severe lung trauma, surgery may be required to repair or remove damaged lung tissue.

It is important for patients to undergo a thorough evaluation by a healthcare provider to determine if lung surgery is the appropriate treatment option for their condition. Additionally, the risks and benefits of surgery should be carefully considered before making a decision.

Timeline

Before lung surgery, a patient will typically undergo a series of pre-operative tests and evaluations to assess their overall health and suitability for the procedure. This may include blood tests, imaging scans, and pulmonary function tests. The patient will also meet with their surgical team to discuss the procedure, potential risks and complications, and post-operative care.

On the day of surgery, the patient will be prepped for the procedure and given anesthesia. The surgeon will then perform the necessary incisions and remove the affected part of the lung. After the surgery is completed, the patient will be taken to the recovery room and monitored closely for any complications.

After lung surgery, the patient will typically stay in the hospital for a few days to recover. They will be closely monitored for any signs of infection, bleeding, or other complications. Pain management will be provided to help with any discomfort. Physical therapy may also be recommended to help the patient regain strength and mobility.

In the weeks and months following surgery, the patient will have follow-up appointments with their surgical team to monitor their recovery and address any concerns. They may also be prescribed medication or breathing exercises to help improve lung function. Over time, the patient should experience improved breathing and overall health as they continue to recover from the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about lung surgery include:

  1. What type of lung surgery will I be undergoing and why is it necessary?
  2. What are the potential risks and complications associated with this surgery?
  3. How long will the recovery process be and what can I expect in terms of pain management?
  4. Will I need to undergo any additional testing or preparation before the surgery?
  5. What type of anesthesia will be used during the surgery and what are the potential side effects?
  6. How will my breathing be affected during and after the surgery?
  7. Will I need to undergo any physical therapy or rehabilitation after the surgery?
  8. How will the open lung approach (OLA) be utilized during my surgery and what are the potential benefits?
  9. What are the expected outcomes of the surgery in terms of lung function and overall health?
  10. Are there any specific lifestyle changes or precautions I should take after the surgery to promote healing and prevent complications?

Reference

Authors: Rauseo M, Mirabella L, Grasso S, Cotoia A, Spadaro S, D’Antini D, Valentino F, Tullo L, Loizzi D, Sollitto F, Cinnella G. Journal: BMC Anesthesiol. 2018 Oct 31;18(1):156. doi: 10.1186/s12871-018-0624-3. PMID: 30382819