A randomised controlled trial on roles of prostaglandin E1 nebulization among patients undergoing one lung ventilation

Background Prostaglandin E1 (PGE1) has been reported to maintain adequate oxygenation among patients under 60% FiO 2 one-lung ventilation (OLV). This research aimed to explore whether PGE1 is safe in pulmonary shunt and oxygenation under 40% FiO 2 OLV and provide a reference concentration of PGE1. Methods Totally 90 esophageal cancer patients treated with thoracotomy were enrolled in this study, randomly divided into three groups (n = 30/group): Group A (60% FiO 2 and 0.1 µg/kg PGE1), Group B (40% FiO 2 and 0.1 µg/kg PGE1), and Group C (40% FiO 2 , 0.2 µg/kg PGE1). Primary outcomes were oxygenation and pulmonary shunt during OLV. Secondary outcomes included oxidative stress after OLV. Results During OLV, patients in Group C and B had lower levels of PaO 2 , SaO 2 , SpO 2 , MAP, and Qs/Qt than those in Group A ( P < 0.05). At T2 (OLV 10 min), patients in Group C and B exhibited a lower level of PaO 2 /FiO 2 than those in Group A, without any statistical difference at other time points. The IL-6 levels of patients in different groups were different at T8 (F = 3.431, P = 0.038), with IL-6 in Group C being lower than that in Group B and A. MDA levels among the three groups differed at T5 (F = 4.692, P = 0.012) and T7 (F = 5.906, P = 0.004), with the MDA level of Group C being lower than that of Group B and A at T5, and the MDA level of Group C and B being lower than that of Group A at T7. In terms of TNF-α level, patients in Group C had a lower level than those in Group B and A at T8 (F = 3.598, P = 0.033). Compared with patients who did not use PGE1, patients in Group C had comparable complications and lung infection scores. Conclusion The concentration of FiO 2 could be reduced from 60 to 40% to maintain oxygenation. 40% FiO 2 + 0.2 µg/kg PGE1 is recommended as a better combination on account of its effects on the inflammatory factors. Trial registration: Chictr.org.cn identifier: ChiCTR1800018288, 09/09/2018.